Type 2 Diabetes – Immediate Release or Extended Release Anti-Diabetic Drugs?

Researchers at the University of Pavia in Pavia, Italy, have found the drug metformin extended release (XR) formula to be more efficient at controlling Type 2 diabetes than the drug metformin immediate release (IR) formula. In a study reported on in May of 2017 in the journal Drug Design and Developmental Therapy, two hundred and fifty-three people diagnosed with Type 2 diabetes had HbA1c levels between 7.0 percent and 8.5 percent (poor control). For six months these Type 2 diabetics were divided into two groups and received either…

  • 1,000 to 3000 mg of metformin IR, or
  • 500 to 1500 mg of metformin XR per day.

By the end of the study weight loss was about the same in both groups. The Type 2 diabetics taking metformin XR showed greater improvement in their…

  • insulin sensitivity,
  • blood sugar control,
  • total cholesterol, and
  • LDL cholesterol or “bad” cholesterol levels.

Metformin XR lowered the levels of visfatin, a hormone recently discovered in fat cells. Visfatin lowers blood sugar levels by preventing the liver from releasing sugar. Fat cells release more visfatin when blood sugar levels go up and less when insulin levels go up. Although it works mostly in belly fat cells, visfatin is also found in the brain, kidneys, lungs, spleen, and testes. Its relationship to Type 2 diabetes is not yet clear. More research is needed to tell us the role of visfatin in maintaining normal blood sugar levels.

Metformin XR also lowered TNF-alpha and hs-CRP, inflammatory molecules, as well as vaspin thought to be released by belly fat. Vaspin is linked with insulin sensitivity and goes up with physical activity. Physical activity is also related to lower insulin resistance. Vaspin may explain how exercise lowers insulin resistance. More research will discover its role in metabolism.

Metformin (Glucophage) works by lowering the amount of sugar the liver makes and the intestines absorb. Immediate-release (IR) metformin is given at the rate of 500 mg twice a day or 850 mg once a day to begin. Gradually the dose is increased to the effective amount. The gradual increase in the drug is so the person with Type 2 diabetes does not get digestive upset by taking the required dose too early. Within a few weeks, the dose is increased to 2000 mg to 2550 mg per day.

Extended-release (ER) metformin is given once a day at bedtime. It begins with a dose of 500 to 1000 mg per day and goes up to 2000 to 2500 mg per day.