You will be happy to know that I have written an entire post on the NNT for our best practice protocol to treat type 2 diabetes. It is better than any other NNT I have ever seen. You only need to treat 5 patients with type 2 diabetes to prevent a major cardiovascular event. Here is a link to the post.
NNT info helpful when compared to other treatments.
But an NNT of 5, still means only 1 out of 5 people will benefit. That’s still only 20% of people. Or 4 out of 5 will not benefit from using metformin to prevent an outcome.
I actually like metformin and its close cousin Berberine. But, another way to do similar without using a drug is to lower insulin naturally.
Greatly lower your carbs
Intermittent or longer fasts
Increase activity
Reduce stress hormone cortisol
So while metformin is cheap and helps part of the mechanism, if we can get people to do more of the other natural mechanisms to lower insulin, I think the improvements in risk reduction would be even greater.
People in Singapore live longer for one fourth the impact on gross domestic product. The have one stop primary care clinics that have teams to address hypertension, diabetes, and lipids concurrently That approach protects patients. They have one fourth as many heart attacks, one fifth as many strokes and one sixth as many go on dialysis. That is not perfect but it is a huge impact.
If people could do that they wouldn't get type 2 dieabetes in the first place. In practice you might be right, in reality it's much less successful than 20%.
Very few people want to be fat or sick. When they learn easy ways to help themselves they can do much better. Heart attack victims treated with best practices are ten times as likely to be alive in 5 years.
Chris- correct, but ask why they can’t or won’t. Most likely they have been brainwashed by industry and govt that carbs are good and fat is bad and to limit protein. It’s hard to go against the crowd even when they are leading you off a cliff.
Most people think a lot less about food than either of us. If I did a casual survey of the people that I work with during lunch I would say they aren't brainwashed "by industry and govt that carbs are good and fat is bad and to limit protein." They are motivated by tasty food and it makes them feel good.
That is a barrier. You are right. But there is great evidence that metformin slows the progression of prediabetes to diabetes and offers great protection against diabetic complications. You should be able to get metformin in prediabetes. If your doctor won't do it, give him this post. If he still won't do it, I'd find another doctor. Patients on metformin with prediabetes reduced their chance of progression to diabetes and their weight over a ten year period. Simply taking metformin reduces your risk of progressing to diabetes by a third.
go to Portugal. You can get most any drug there. Without a prescription they may cost more, but Metformin is cheap anyway. I got it there as a visitor, no questions asked.
I order Metformin from Mexico as I don’t need a prescription. I have found, what I believe to be a reputable pharmacy there and have ordered from them for many years without issue. I have ordered other pharmaceuticals from them as well. I know there is a lot of hype and fear around out of country mail order pharmacies and it’s true there is reason for concern in some cases but a little research and care can help with wading through the misinformation and scare tactics used to prevent Americans from ordering meds outside the US. There are also Canadian pharmacies one can order from that have good reputations. A lot of people on expensive meds go that route and I can only encourage them given their need for a medication that is priced out of their budget yet can save or prolong their lives; who wouldn’t do the same for a loved one or oneself? You may not be comfortable with this idea but it is an option that people have been using given the insanity we face in the US with getting reasonable priced health care and medications.
Disappointed that your medication recommendations never include “number needed to treat” information.
You will be happy to know that I have written an entire post on the NNT for our best practice protocol to treat type 2 diabetes. It is better than any other NNT I have ever seen. You only need to treat 5 patients with type 2 diabetes to prevent a major cardiovascular event. Here is a link to the post.
https://williamhbestermannjrmd.substack.com/p/lesson-13-the-number-needed-to-treat
Well written article.
NNT info helpful when compared to other treatments.
But an NNT of 5, still means only 1 out of 5 people will benefit. That’s still only 20% of people. Or 4 out of 5 will not benefit from using metformin to prevent an outcome.
I actually like metformin and its close cousin Berberine. But, another way to do similar without using a drug is to lower insulin naturally.
Greatly lower your carbs
Intermittent or longer fasts
Increase activity
Reduce stress hormone cortisol
So while metformin is cheap and helps part of the mechanism, if we can get people to do more of the other natural mechanisms to lower insulin, I think the improvements in risk reduction would be even greater.
People in Singapore live longer for one fourth the impact on gross domestic product. The have one stop primary care clinics that have teams to address hypertension, diabetes, and lipids concurrently That approach protects patients. They have one fourth as many heart attacks, one fifth as many strokes and one sixth as many go on dialysis. That is not perfect but it is a huge impact.
https://www.nejm.org/doi/full/10.1056/NEJMoa0706245
If people could do that they wouldn't get type 2 dieabetes in the first place. In practice you might be right, in reality it's much less successful than 20%.
Very few people want to be fat or sick. When they learn easy ways to help themselves they can do much better. Heart attack victims treated with best practices are ten times as likely to be alive in 5 years.
https://pubmed.ncbi.nlm.nih.gov/20973686/
Chris- correct, but ask why they can’t or won’t. Most likely they have been brainwashed by industry and govt that carbs are good and fat is bad and to limit protein. It’s hard to go against the crowd even when they are leading you off a cliff.
Most people think a lot less about food than either of us. If I did a casual survey of the people that I work with during lunch I would say they aren't brainwashed "by industry and govt that carbs are good and fat is bad and to limit protein." They are motivated by tasty food and it makes them feel good.
Again, tasty “food” if we call it that, is from industrial food, marketed by big food industry, encouraged by govt policies.
But getting one’s doctor to prescribe metformin without diabetes???
That is a barrier. You are right. But there is great evidence that metformin slows the progression of prediabetes to diabetes and offers great protection against diabetic complications. You should be able to get metformin in prediabetes. If your doctor won't do it, give him this post. If he still won't do it, I'd find another doctor. Patients on metformin with prediabetes reduced their chance of progression to diabetes and their weight over a ten year period. Simply taking metformin reduces your risk of progressing to diabetes by a third.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3308305/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10611985/#:~:text=The%20study%20findings%20revealed%20that%20the%20primary,of%20diabetes%20with%20the%20use%20of%20metformin.&text=Moreover%2C%20the%20Diabetes%20Prevention%20Program%20Outcomes%20Study,with%20the%20benefits%20persisting%20over%2010%20years.
go to Portugal. You can get most any drug there. Without a prescription they may cost more, but Metformin is cheap anyway. I got it there as a visitor, no questions asked.
You can order it from India online.
Thanks
I replied to this at length in the general comments section rather than to your post (Vicki Hertz) directly.
AgelessRX online
I order Metformin from Mexico as I don’t need a prescription. I have found, what I believe to be a reputable pharmacy there and have ordered from them for many years without issue. I have ordered other pharmaceuticals from them as well. I know there is a lot of hype and fear around out of country mail order pharmacies and it’s true there is reason for concern in some cases but a little research and care can help with wading through the misinformation and scare tactics used to prevent Americans from ordering meds outside the US. There are also Canadian pharmacies one can order from that have good reputations. A lot of people on expensive meds go that route and I can only encourage them given their need for a medication that is priced out of their budget yet can save or prolong their lives; who wouldn’t do the same for a loved one or oneself? You may not be comfortable with this idea but it is an option that people have been using given the insanity we face in the US with getting reasonable priced health care and medications.
https://agelessrx.com/ is a site where you can access this medication.
Thank you for this reminder