Author Interviews, COVID -19 Coronavirus, Diabetes, Race/Ethnic Diversity / 16.01.2021 Interview with: Anath Shalev, M.D. Professor of Medicine Nancy R. and Eugene C. Gwaltney Family Endowed Chair in Juvenile Diabetes Research Director, Comprehensive Diabetes Center University of Alabama at Birmingham Birmingham, AL What is the background for this study?  What is metformin normally prescribed for? Response: Diabetes has been recognized as one of the major comorbidities associated with higher mortality in the context of the spreading COVID-19 pandemic, but ways to improve outcome in this at-risk population are lacking. Metformin is the most common medication used for type 2 diabetes. In addition, it is sometimes prescribed to people with prediabetes or to women with polycystic ovary syndrome (PCOS). (more…)
Author Interviews, Diabetes, Microbiome / 06.09.2019 Interview with: Prof. Dr. Christoph Kaleta Institute for Experimental Medicine Institute for Experimental Medicine, Kiel University Kiel, GermanyProf. Dr. Christoph Kaleta Institute for Experimental Medicine Institute for Experimental Medicine, Kiel University Kiel, Germany What is the background for this study? Response: Even though Metformin is the first-line treatment option in type-2 diabetic patients, its specific mechanism of action has remained elusive so far. Moreover, metformin is of particular interest as an anti-aging drug since it's usage has been shown to be associated with a lower incidence of several aging diseases in type-2 diabetic patients taking metformin when compared to matched healthy controls. While previous work was able to show pronounced changes in the microbiota of patients taking metformin and a health-promoting effect of metformin-adapted microbiota, how this beneficial effect could be mediated has remained unclear. (more…)
Author Interviews, Diabetes, Weight Research / 23.04.2019 Interview with: Kishore M. Gadde, MD, Professor Fairfax Foster Bailey Endowed Chair in Heart Disease Prevention Medical Director, Clinical Services Pennington Biomedical Research Centre Baton Rouge, LA 70808 What is the background for this study? Response: Around 20 years ago, the Diabetes Prevention Program, DPP, enrolled 3,234 adults with excess body weight and impaired glucose tolerance. The idea was to compare the efficacy of either an intensive lifestyle intervention or metformin relative to placebo in preventing diabetes. Over approximately 3 years, both lifestyle and metformin were effective, but lifestyle intervention was better for weight loss as well as in reducing the risk of diabetes. After the blinded treatment phase ended, the researchers continued to follow this cohort in their originally randomised groups.  (more…)
Author Interviews, BMJ, Boehringer Ingelheim, McGill, Pharmacology / 19.07.2018 Interview with: Samy Suissa, PhD Director, Centre for Clinical Epidemiology, Lady Davis Institute Professor, Departments of Epidemiology and Biostatistics and of Medicine McGill University What is the background for this study? What are the main findings? Response: Sulfonylureas are widely used oral antidiabetic drugs that are recommended as second-line treatments after first-line metformin to treat patients with type 2 diabetes. While their safety has been studied extensively, studies in patients with poorly controlled diabetes in need of pharmacotherapy escalation have been sparse and limited. Our study evaluated whether adding or switching to sulfonylureas after initiating metformin treatment is associated with increased cardiovascular or hypoglycaemic risks, compared with remaining on metformin monotherapy. Using a large cohort of over 77,000 patients initiating treatment with metformin monotherapy, we found that adding or switching to sulfonylureas is associated with modest increases of 26% in the risk of myocardial infarction and 28% in the risk of death, as well as an over 7-fold major increase in the risk of severe hypoglycaemia leading to hospitalisation. In particular, we found that switching from metformin to sulfonylureas was associated with higher risks of myocardial infarction and death, compared with adding sulfonylureas to metformin.  (more…)
Author Interviews, Autism, Diabetes, McGill, Nature / 24.05.2017 Interview with: Ilse Gantois, PhD Research Associate Dr. Nahum Sonenberg's laboratory Department of Biochemistry McGill University What is the background for this study? What are the main findings? Response: Fragile X syndrome (FXS) is a neurodevelopmental disorder characterized by cognitive impairment and affects 1 in 4000 males and 1 in 6000 females. About 60% of persons with Fragile X also have autism spectrum disorder. FXS is caused by absence of Fragile X protein (FMRP), which results in hyperactivation of ERK (extracellular signal-regulated kinase) and mTORC1 (mechanistic target of rapamycin complex 1) signaling. We show that treatment with metformin, the most widely used FDA-approved antidiabetic drug, suppresses translation by inhibiting the ERK pathway, and alleviates a variety of behavioural deficits, including impaired social interaction and excessive grooming. In addition, metformin also reversed defects in dendritic spine morphogenesis and synaptic transmission. (more…)
Author Interviews, Cancer Research, Diabetes, Pharmacology, Science / 05.01.2017 Interview with: Dr. Don Gary Benjamin Biozentrum, University of Basel Basel, Switzerland. What is the background for this study? What are the main findings? Response: We initiated the study to find a co-drug that would increase the anti-cancer effect of the commonly prescribed anti-diabetic drug metformin. Metformin is a very well tolerated medication, however the dosage required to show anti-cancer activity is higher than that usually prescribed, hence the aim of the study. We found that metformin in combination with a second drug, syrosingopine (an anti-hypertensive), potently kills cancer cells in a variety of pre-clinical models. Quite nicely, both these drugs combine to kill the cells at a concentration where they have no impact on cell growth when applied singly. (more…)
Author Interviews, JAMA, Kidney Disease / 12.01.2015 Interview with: James Flory MD, MSCE Division of Endocrinology and Department of Healthcare Policy and Research Weill Cornell Medical College, NY NY Medical Research: What is the background for this study? What are the main findings? Dr. Flory: Metformin is the first-line drug for type 2 diabetes, with much better evidence for safety and improved clinical outcomes than any alternative. The one major safety concern about metformin is the fear that it can cause lactic acidosis, which led to a Food and Drug Administration black box warning against using metformin in patients with even a modest degree of renal impairment. These fears and warnings were based on serious problems with an older drug in the same class, not on experiences with metformin itself, and over the past 20 years it has become clear that the risk of lactic acidosis with metformin is extremely low, and that this warning against the use of the drug in mild renal failure is overly strict. (Dr. Lipska and colleagues published a superb review of this issue a few years back: Diabetes Care June 2011 vol. 34 no. 6 1431-1437) This is important from a public health perspective because so many patients with diabetes have mild to moderate kidney disease, and we were concerned that the FDA warning was preventing the use of metformin in these patients. Our study was intended to estimate how many patients who would benefit from metformin are not taking it because they have mild kidney disease. We found that rates of metformin use are much lower in patients with mild kidney disease – just the population where the FDA warning discourages use, but modern data show that metformin is safe. In all, at least 1 million patients with type 2 diabetes who would benefit from metformin appear not to be taking it because clinicians are following the FDA warning and being too conservative. (more…)
Author Interviews, Diabetes, PNAS / 07.06.2014

Wouter De Haes Functional Genomics and Proteomics (Schoofs lab) Zoological Institute Leuven Interview with: Wouter De Haes Functional Genomics and Proteomics (Schoofs lab) Zoological Institute Leuven Belgium MedicalResearch: What are the main findings of the study? Answer: We discovered that the lifespan-extending effect of metformin is dependent on the increased production of reactive oxygen species in the roundworm Caenorhabditis elegans. Antioxidants, compounds that remove these reactive oxygen species, abolished the lifespan-extending effect of metformin, adding to the growing body of evidence that anti-oxidants are not as beneficial for health as generally assumed. We also identified the protein, belonging to the group of peroxiredoxins, that seems responsible for translating this increase in reactive oxygen species production into longevity. (more…)
Author Interviews, Diabetes, Diabetes Care, Pharmacology / 29.05.2014

MedicalResearch Interview with: Dr. Valeria Pechtner Medical Advisor, Lilly Diabetes MedicalResearch: What are the main findings of the study? Dr. Pechtner: Used as monotherapy, once-weekly dulaglutide resulted in significant, sustained glycemic lowering, as measured by HbA1c change from baseline. Both the 1.5 mg and the 0.75 mg dose were superior to metformin at the primary endpoint of 26 weeks. At 52 weeks, dulaglutide 1.5 mg continued to demonstrate superiority to metformin, with dulaglutide 0.75 mg showing non-inferiority. In addition, a majority of patients in all arms achieved the American Diabetes Association’s recommended HbA1c target of less than 7 percent, with more patients achieving this goal in the dulaglutide groups at the 26-week endpoint, and more patients achieving the target in the dulaglutide 1.5 mg group at the 52 week timepoint. Additionally, dulaglutide 1.5 mg and metformin resulted in similar weight loss. The tolerability and safety profile was comparable for both medications. (more…)
Author Interviews, Endocrinology, JCEM / 28.04.2014

Dr. Dorte Glintborg PhD Senior Hospital Physician, PhD Dorte Glintborg, Department of Endocrinology, OUH Odense University Interview with: Dr. Dorte Glintborg PhD Senior Hospital Physician, PhD Dorte Glintborg, Department of Endocrinology, OUH Odense University Hospital What are the main findings of this study? Dr. Glintborg: The main finding of the study is that one year’s metformin treatment is associated with a minor but significant weight loss in patients with PCOS irrespective of BMI at study inclusion. Treatment with oral contraceptives improves sex-hormone levels but is associated with at minor weight gain. Based on the study results, clinicians should consider the combined treatment with metformin and oral contraceptives in patients with PCOS. (more…)