Dear Dr. Roach: What is your personal experience with the natural progression of Type 2 diabetes? Are medications like metformin used with the hope that the diabetes will get a little better or at least not get any worse? Does monotherapy usually progress to the use of multiple diabetic drugs and then eventually to insulin depletion, with required insulin shots?
R.I.
Dear R.I.: Type 2 diabetes is mostly about resistance to insulin, and in general it can be treated by reducing insulin needs or by increasing insulin. Metformin works by reducing the amount of sugar made by the liver, thereby reducing the amount of insulin needed. This improves blood sugar in the short term, and in the long term, it helps the pancreas by giving it a bit of a rest.
In contrast, the oldest oral medicines, like glyburide, work by forcing the pancreas to make more insulin. Most people on these medicines fail after several years and need different treatment (which used to be insulin, before we had the myriad of choices we have now).
In my experience, many people recently diagnosed with Type 2 diabetes do very well on metformin alone, especially if they make some changes to their lifestyle. The critical changes are to reduce sugar intake (both simple sugars and processed carbohydrates, like most white breads, which the body rapidly converts to sugar) and to increase sugar utilization through exercise (which also reduces insulin resistance). The combination of improved diet and more exercise helps most people lose weight, which further improves diabetes control.
There are many other choices of medication for people with Type 2 diabetes now, both oral and injection. But metformin by itself, along with diet and exercise, is effective for many.
http://www.detroitnews.com/story/life/advice/2016/07/15/best-treatments-diabetes/87151016/
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