Curious if this community has any Type 1 diabetics using metformin as a longevity supplement in addition to their prescribed insulin? Can you share improvements with blood sugar regulation or any other noticeable improvements?
Hello! This is Brandon from the Healthspan Clinical Team. I hope to shed some light on Type 1 diabetes (T1D) and the use of Metformin for longevity purposes rather than the traditional blood sugar control seen in those affected by Type 2 diabetes (T2D). First, I’d like to quickly differentiate between T1D and T2D to set the stage. The clinical objectives for managing each differ due to the underlying causes of the conditions, though both aim to control blood sugar levels and prevent complications.Type 1 diabetes is an autoimmune condition where the body’s immune system destroys insulin-producing beta cells in the pancreas, leading to a complete lack of insulin. Therefore, the primary objective is to provide insulin through injections or an insulin pump to replace the body’s natural insulin. Continuous monitoring of blood glucose levels and adjusting insulin doses is paramount to maintaining blood sugar within a healthy range. This includes using short-acting insulin for meals and long-acting insulin to maintain baseline levels. Patients must balance insulin, food intake, and physical activity to avoid dangerously low (hypoglycemia) or high (hyperglycemia) blood sugar levels. Maintaining tight glycemic control is also important to prevent long-term complications like cardiovascular disease, neuropathy, kidney disease, and eye problems.On the other hand, T2D is typically characterized by insulin resistance, in which the body does not use insulin effectively, and the pancreas may produce less insulin over time. The primary goal is to enhance the body’s response to insulin. This can be achieved through lifestyle changes like diet, exercise, and weight loss, as well as medications like Metformin. Like T1D, the aim is to control blood sugar levels, but often with oral medications (e.g., Metformin, sulfonylureas, GLP-1 receptor agonists) and sometimes insulin in advanced stages. Diet and exercise are critical in T2D management. Weight loss can significantly improve insulin sensitivity and may even lead to remission. Since T2D is often associated with metabolic syndrome, managing cholesterol, blood pressure, and weight is crucial to reduce the risk of heart disease and stroke. As in T1D, the objective is to prevent complications like neuropathy and retinopathy, but with an additional focus on managing coexisting conditions like obesity and hypertension.Healthspan does not yet have internal data specifically to report in individuals with T1D managing their blood sugar with insulin and Metformin, however, the American Diabetes Association (ADA) has examined the combined use of insulin and Metformin in the management of Type 1 diabetes. Though insulin remains the cornerstone of treatment for T1D, the off-label use of Metformin alongside insulin is aimed at addressing insulin resistance and reducing insulin requirements. Studies have shown that patients on both insulin and Metformin tend to require lower insulin doses compared to those using insulin alone [1,2]. With improvements in insulin sensitivity, and therefore less circulation of this fat-storage-promoting hormone, Metformin may also help prevent weight gain, a common issue in people with T1D who are on intensive insulin therapy [1]. While the effect on HbA1c (a long-term marker of blood sugar control) may vary across studies, some have shown modest reductions in HbA1c when Metformin is added to insulin therapy [2]. Metformin has been shown to reduce markers of metabolic syndrome, such as fasting blood glucose and triglyceride levels, which are important for cardiovascular health.Although direct evidence of Metformin’s effect on healthspan in T1D is limited, it is being explored for its ability to reduce markers of aging and metabolic stress in various populations. The TAME (Targeting Aging with Metformin) trial is one of the largest ongoing studies assessing Metformin’s impact on aging, including its potential use in people with T1D [3]. When all is said and done, TAME will result in a six-year study across 14 sites, with over 3,000 individuals between the ages of 65-79, with the hopes of answering whether those taking Metformin experience delayed development or progression of age-related chronic diseases—such as heart disease, cancer, and dementia.If members of the Healthspan community are managing T1D with the use of Metformin as an adjuvant therapy, we would love to hear from you and share in your successes!**Footnote: we have written about Metformin previously here, and is worth a review in understanding Metformin in the context of longevity potential.
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Beysel, S., Unsal, I.O., Kizilgul, M. et al. The effects of metformin in type 1 diabetes mellitus. BMC Endocr Disord 18, 1 (2018). The effects of metformin in type 1 diabetes mellitus | BMC Endocrine Disorders | Full Text
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Vella, S., Buetow, L., Royle, P. et al. The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia 53, 809–820 (2010). The use of metformin in type 1 diabetes: a systematic review of efficacy | Diabetologia
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American Federation for Aging Research. (2024). Targeting the Biology of Aging. Ushering a New Era of Interventions. afar.org. TAME - Targeting Aging with Metformin - American Federation for Aging Research