Type 2 Diabetes - Which Diabetes Medication Works Best After A Heart Attack?

A group of researchers in the Cardiology Unit, Department of Medicine, Karolinska Institute in Sweden, set out to discover how diabetics who had suffered a heart attack responded to various kinds of treatments. The results of their work were published in the February 2011 publication of the journal Diabetologia.

One thousand one hundred and forty-five patients with Type 2 diabetes who had suffered a heart attack were included in the study. They were divided into three groups who:

• received either insulin


• insulin while in hospital and conventional treatment afterward, and


• only conventional treatment for 2.1 years

The volunteers were followed for an average of 4.1 years. The number of fatal heart attacks was about the same in all groups. The number of non-fatal heart attacks was greatest in the insulin-treated groups. The group with conventional treatment only, had a lower risk of death from cancer than either of the other two groups. Type 2 diabetics taking metformin had a lower risk of death and lower risk of cancer than other patients.

Metformin tablets (Glucophage, Glucophage XR, Fortamet), is an oral blood sugar lowering medication. It is usually used as first-line therapy for Type 2 diabetes and can also be used to prevent Type 2 diabetes in people at high risk. One study in Canada showed that metformin and Avandia together lowered the risk of diabetes in prediabetic volunteers.

This oral blood sugar lowering medication is taken once, twice, or three times a day as prescribed. It is usually started as 500mg twice per day or 850mg once a day. The dose can be gradually increased depending upon how blood sugars react.

Metformin has more than one mechanism of action:

• it lowers intestinal absorption of sugar


• increases insulin release from the pancreas


• lowers sugar production in the liver, and


• helps the muscle and fat cells respond to insulin. (The function of insulin is to help the cells to take in sugar).

Possible Side Effects: Metformin is basically safe but, like all medications, can have side effects. The most serious of them is lactic acidosis. The signs and symptoms of lactic acidosis are:

• fatigue


• dizziness


• sleepiness


• chills


• cool or blue skin


• muscle pain


• fast or difficult breathing


• slow or irregular heartbeats


• abdominal pain


• nausea


• vomiting or diarrhea.

The drug rarely causes hypoglycemia, or low blood sugar, but this is a possibility as well, and can also occur when metformin is prescribed with other anti-diabetic drugs. Signs and symptoms of low blood sugar include sweating, shaking, heartbeat, unusual hunger, blurred vision, dizziness and tingling in the hands or feet.

Since metformin is excreted in the urine, it must be used with caution in patients with kidney problems. Elderly patients should have kidney function tests before starting this medication. Type 2 diabetics taking metformin are advised to stop the medication a few days before having xray procedures with contrast.