THIS letter is written to respond to the concerns from our community regarding the use of metformin (also known as glucophage) for diabetics in the CNMI.
Since 1996, doctors have been prescribing metformin for diabetes. It is very good medicine. Hundreds of people in the CNMI have been able to avoid insulin shots because metformin has helped them control their diabetes and control their weight. There has never been a death in the CNMI that was caused by this medicine. There have been many deaths in the CNMI because of failure to take metformin along with other important diabetic medications.
In the CNMI, an average of six diabetics die from complications of their diabetes each month. These deaths are from heart attacks, strokes, and kidney failure. None of the deaths are from lactic acidosis. Most of the deaths could have been prevented or delayed if diabetics could improve diet, increase daily exercise, quit smoking, and take medicines according to the doctor’s recommendations.
According to the latest research, metformin can cause lactic acidosis, which can lead to death in 1 percent for every 100,000 patient-years. What does this mean for the CNMI, where about 500 patients are taking this important medicine? The answer is complicated, but it means that we might expect a single serious complication from metformin on Saipan in 1 percent over the next 200 years.
In other words, sometime in the next two centuries, we might expect a single serious case at Commonwealth Health Center of lactic acidosis caused by metformin. In the same time period, we will most assuredly witness the premature death of more than 15,000 diabetic friends and relatives in the CNMI from complications of diabetes. One way to prevent many of these deaths is for diabetics to continue to take the medications their doctor has given them.
All the doctors who care for diabetic patients are aware of the potential dangers of metformin and other medications. If you are worried about the medication your doctor has given you, please call or make an appointment with your local doctor or pharmacist.
It is correct for diabetics in the CNMI to be concerned that their health is in danger. The danger is not from metformin, however, The real danger is for those who are not mindful of their illness. Medication is very important, but diabetics also need to make sure that they are very careful about their diet, get exercise (like walking) everyday, and face the challenge of quitting smoking. These lifestyle changes are very, very challenging.
To the many diabetics who have already changed their diet, started walking, and quit smoking, congratulations! You serve as an example for others in the CNMI and elsewhere. To diabetics who are still struggling with proper diet, exercise, and/or smoking, I wish for you the strength needed to make yourself healthier. Diabetes affects all of us in the CNMI. There is no health issue here that is more important!RICHARD BROSTROM, M.D.
Medical Director,
Division of Public Health
