Diabetes Medicine Metformin for Moon Face - PMRGCAuk

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Diabetes Medicine Metformin for Moon Face

Estellemac profile image
25 Replies

Got this from the Daily Mail today. See what you think.

HEALTH

15p diabetes drug ends the dreaded ‘moon face’ side effect of steroids

By Vivienne Parry

A DAILY pill could bring an end to the most dreaded side effects of steroid medication - including the much- hated ‘moon-face’, where the face swells to such an extreme that it becomes unrecognisable.

About two million people in the UK take potentially life-saving steroids to treat chronic conditions including inflammatory bowel diseases such as colitis, asthma, severe allergic reactions and arthritis.

But almost all patients who have to take high doses to manage their illness will get side effects.

So-called moon-face is not harmful, physically, and patients usually return to normal once they’ve finished their course of tablets.

Although not all patients experience this, in those that do the change in appearance can be dramatic - and cause significant distress.

The puffiness is actually abnormal accumulations of fat, typically around the face and neck, but it can also sit on the abdomen.

Now, experts believe a 15p-a-day drug taken by millions of patients with type 2 diabetes, could offer a cheap and simple solution.

A new study by researchers at Queen Mary University of London found the pill metformin, which lowers the blood sugar levels of type 2 diabetics, could reverse the unwanted side effects of steroids.

‘This is really exciting, because it means we might - at last - have a way of preventing the serious side effects that limit the use of these life-saving drugs,’ says Marta Korbonits, professor of endocrinology and metabolism at Barts Health NHS Trust and Queen Mary University of London.

Steroids, also called corticosteroids, work by reducing activity in the immune system. This limits inflammation, alleviating pain and other symptoms.

But prolonged use of the drugs at the high doses needed for some patients comes at a price. The drugs can have serious side effects, changing the way the body processes and stores energy.

Steroids trigger the release of excess hormones which cause a build up of fatty deposits around the face. Doctors refer to this medically, as Cushingoid, although colloquially it is termed moon-face.

Experts are able to identify if the swelling is a direct result of the steroid treatment by using a series of blood and urine tests.

This will then flag up unusually high levels of hormones, typically seen in a patient taking steroids for a number of months. The effects are most noticeable around the chin and the cheeks, making the face look particularly rounded.

Most studies show that in roughly eight out of ten patients, this symptom continues for three months after finishing the course of the drug. Some trials show that it can last for up to six.

It is possible to reduce the side effect by reducing the steroid dose, or having one day off the pill, followed by one day on.

Steroids can also lead to an increased appetite, weight gain and loss of muscle and bone mass. Steroids also put patients at a higher risk of diabetes, infections and - in very rare cases - can lead to the development of Cushing’s syndrome, a debilitating disorder where the body has too much of a hormone called cortisol.

Excess cortisol - responsible for regulating a variety of processes including mood and metabolism - causes a hormone imbalance, leading to dangerously high blood pressure, bone fractures and rapid weight gain.

Having assessed previous research on the chemical properties of metformin, Queen Mary University of London researchers believed the drug may offer a solution to this.

They carried out a three-month trial involving 53 patients with either lung disease or arthritis.

All were prescribed high doses of a type of steroids called glucocorticoids, which are commonly given for both conditions.

The patients were told to take an additional pill alongside their steroids and divided into two groups.

Half were given metformin and the other half were given a placebo, or dummy pill. At the end of the experiment, all of the patients who took metformin saw improvements, including a significant reduction in swelling of the face.

In fact almost all patients in the experimental group saw their moon-face all but disappear.

The steroids were also more effective at reducing inflammation caused by their condition when combined with the diabetes drug.

Side effects related to the dampening down of the immune system, such as infection, typical with steroid treatment, were fewer, too.

The steroids-only group had a third more infections, as well as a greater number of hospital admissions.

Kevin Hough, 55, from East London, is one of those who took part in the trial.

Mr Hough, an IT analyst who works for the NHS, began taking steroids in 2012 to treat inflammation and scarring on his lungs, caused by a condition called interstitial lung disease.

The condition, which can be genetic, leads to extreme breathlessness and recurring chest infections. Patients can become severely unwell and unable to breathe at all, with some only surviving three to five years after diagnosis.

Mr Hough suffers from another rare condition which causes red, scaly rashes on the skin, called dermatomyositis, and is doctors told him the steroids would be effective for treating this, too.

He says: ‘Taking steroids was like flicking a light switch. Within 24 hours, not only was my breathing better, but I was no longer fatigued.’

Alongside his steroids, he was given the additional pill - but was not told whether it was metformin or a placebo.

As soon as he stopped taking it at the end of the trial, his steroids began to cause side effects.

‘Almost immediately, I started developing a moon-face,’ he says. ‘That’s when I knew I must have been taking the metformin.’

Experts hope metformin has the potential to help many more patients like Mr Hough, who rely on steroids to manage their health.

‘It’s a very important study,’ says independent expert Professor Jeremy Tomlinson, of the University of Oxford who heads the Oxford Centre for Diabetes. ‘The issue of Cushingoid symptoms around the face and neck affects thousands of people for whom we currently have no treatment.’

But Prof Korbonits is careful to urge caution.

‘This was a small and short study,’ she says.

‘So we need to see if these beneficial effects can indeed be replicated in the long term.’

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Estellemac
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25 Replies
scats profile image
scats

Sounds hopeful!

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer

I know a few people who have taken Metformin for Diabetes, late hubby included, and none were very happy with side effects of that drug on digestive system- so be careful what you wish for!

I think I’d stick with the moonface.😳

Smokygirl profile image
Smokygirl in reply to DorsetLady

Our type 1 diabetic son had to try metformin as an additive to his insulin. He had some really nasty side effects and had to stop taking it.

York54 profile image
York54 in reply to DorsetLady

I take slow release metformin and have no side effects!! The ordinary metformin , however, did leave its mark!!! Lol😂😂

AnnTique profile image
AnnTique in reply to York54

I took slow release metformin and it did some awful things to my digestive system! After going through 3, yes 3 colonscopies, which were very uncomfortable to the point of being painful, even under light sedation, they finally decided it was all down to the Metformin. I stopped taking it. My sugar levels went up by about 1 point but my stomach went back to normal. Till then I was vertually chained to the toilet!!

My sugar levels went back to where they were before within a couple of months.

I would not touch it again for all the tea in China!!

in reply to AnnTique

I am sorry you had such problems! And glad you tracked down the issues. But not everyone gets such effects to metformin and it kept me stable for years. So people don't be put off before you try it.

For diabetes that is.

I have been o. Metformin for 20yrs and even though only 15mg prob a year and reducing from there I did get a decidedly rounded face, the hump and elvis chops. I take 3000mg a day in 3 doses... Mmmm not sure it'll work in all cases!

piglette profile image
piglette in reply to

QED!!

Yellowbluebell profile image
Yellowbluebell

My only concern about this is doctors calling a moon face "a serious side effect"!! A moon face is not that attractive to most of us but hardly serious. YBB

paulus65 profile image
paulus65 in reply to Yellowbluebell

I agree.

I have been on Pred for about 2 years and metformin for about a year because of steroid induced diabetes. The pred probably caused a bit of "moonface" but I haven't noticed that metformin made much difference - to face or digestion.

Yellowbluebell profile image
Yellowbluebell in reply to paulus65

It doesnt seem to work for everyone apparently. Not a miracle cure unfortunately! YBB

SheffieldJane profile image
SheffieldJane

How interesting! Thanks for sharing.

PMRCanada profile image
PMRCanada

I’m wondering what the impact is on taking Metformin when you DON’T have diabetes?? Would it not interfere with blood sugar levels, etc?

Interesting though.

in reply to PMRCanada

thelancet.com/journals/land...

LIVEORDIEHEREIAM profile image
LIVEORDIEHEREIAM in reply to

That link is from 6 years ago....

in reply to LIVEORDIEHEREIAM

Yes... I didn't have much time. But its been on diabetes websites several times and metformin is touted as a go to drug for something in mice or rats several times a year.

in reply to LIVEORDIEHEREIAM

You are welcome to search more recent stuff out and share it. 👍

Estellemac profile image
Estellemac in reply to PMRCanada

That was my thought as I don’t have Diabetes.

Mahnahvu profile image
Mahnahvu in reply to PMRCanada

I was at pre-diabetic glucose levels when I started treatment for PMR. I was able to control the raised blood sugar levels that are part of taking prednisone by eating a low carb diet. However, when I developed GCA and was put on high dose prednisone, I requested a prescription of metformin to help better control the blood sugar levels, which were already at my maximum safe levels before taking a single bit of food.

FnF36 profile image
FnF36

I’m on Metformin and the mirror tonight said I look great😁

powerwalk profile image
powerwalk in reply to FnF36

😂

in reply to FnF36

I take Metformin 500mg x 2 daily, cant tolerate anymore on digestive system. I looked in the mirror too - lovely! No moon face! Mind you, I've now got steroid induced cataracts, both eyes everything blurred and soft.

Estellemac profile image
Estellemac

Thanks to everyone for your thoughts and contributions. The researchers should use stats like these perhaps to inform decisions.

clieder profile image
clieder

Very interesting. More to come, I'm sure. Thanks for sharing it.

I noticed the emphasis on "dreaded" moon face, too. Our priorities may differ?

PMRpro profile image
PMRproAmbassador

All most people really need to do to get a similar effect is to cut carbs. And THAT has no adverse effects. I really struggle with the idea of using a drug to give patients permission to continue with an unhealthy diet or lifestyle!

Plus - if "dreaded moon face" is the worst of your problems stop complaining!!!!!!!

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