Why People with Type 1 Should Care About Metformin

Hi there, faithful reader with Type 1 diabetes, let’s talk about two subjects: heart disease and metformin.

WAIT, WAIT, don’t click away. I can almost feel you putting up your “this is a Type 2 issue” deflector shield. I know that people with Type 1 feel lost in all the public health discussions of Type 2 diabetes, and yes, heart disease is certainly a big-time issue with people with Type 2 diabetes.

Here’s the thing, though: heart disease doesn’t care what type of diabetes you have. And while I know we discuss the ever-present danger of hypoglycemia a lot more than heart disease, the fact of the matter is that heart disease is your biggest long-term risk for staying upright on this planet if you have Type 1 diabetes.

There are two reasons people with Type 1 have to worry about heart disease: First, having Type 1 diabetes doesn’t make you exempt from the dangers of sedentary living or obesity; in fact, insulin therapy helps make those two issues a common problem in the Type 1 community, as too many avoid exercise out of fear of hypoglycemia. Secondly, blood sugar fluctuations damage blood vessels long-term. So heart disease is the big baddie waiting at the end of the video game.

Let’s get back to metformin, a common Type 2 diabetes drug which researchers sometimes prescribe for those with Type 1 diabetes, especially those with obesity. Over the past few years, researchers have been realizing this old drug has a whole bunch of possible hidden health benefits for those who take it, including that it seems to help mitigate dementia, Alzheimer’s, Parkinson’s, and symptoms of pancreatic cancer, among other things. They keep finding more good things about it; it’s like a clown car of discoveries.

This year, Type 1 researchers added their contribution. A big international study with a fancy acronym (REMOVAL) found that long-term metformin use may be an effective way for people with Type 1 to reduce the risk of heart disease, according to an ADA press release at the Scientific Sessions this past summer.

Researchers gave either metformin or a placebo to 428 middle-aged people with Type 1 diabetes who had three or more risk factors for heart disease (A1C over 8.0, BMI over 27, smokers, high blood pressure, etc.). They then used an ultrasound to measure thickening (atherosclerosis) in the carotid arteries – important arteries in the neck; they used this measurement as a stand-in for actual cardiovascular events. What they found was that those who took the metformin had less thickening, meaning they were less at risk for heart disease. Researchers also found that they lost weight and had lower cholesterol levels, even after taking statin use into account.

Now, before you go thinking that either I or the researchers are in the back pocket of the metformin lobby, first remember that metformin is a cheap, cheap drug; there is no money in these results. Maybe someone will create a new formulation of metformin and mark the price up (cough cough insulin), but right now you can get it at a bargain. Secondly, the news wasn’t all sunshine and roses for metformin; the researchers found that taking the drug really didn’t provide a lasting improvement on A1C levels, as had been previously reported in past studies.

Bottom line of this study: metformin – seemingly good for the heart, and not just a Type 2 thing.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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