Loss of kidney function prompts concern with long-time meds
DEAR DR. ROACH »
I took Glucovance (metformin and glyburide) for more than 30 years. Then, because of worsening kidney function (high creatinine), I have been switched to just glyburide alone. I am also on Actos for my diabetes. I just joined Medicare Part D; however, there were only one or two plans that covered glyburide. Why do drug companies push metformin if it worsens kidney function?
DEAR C.S.» Metformin and glyburide are both older medications for Type 2 diabetes, and both are quite inexpensive — less than $5 per month in the U.S. using one of the online discount programs, without needing insurance. Part D providers are generally happy to pay for these less-expensive alternatives to newer medications, but the newer medicines are much better for some people.
Glyburide, for example, tends to promote weight gain and stops working in many people after several years, especially when used by itself. Metformin remains a first-line oral medication for many, but it is not safe in people with more-than-mild kidney problems — and is not responsible for the kidney problems itself. Diabetes, especially if not wellcontrolled, accelerates the normal loss of kidney function with age. Metformin in someone with poor kidney function can cause a dreaded complication called lactic acidosis.
Pioglitazone (Actos) is another older drug that is not recommended for first-line use, due to a small increase in risk of heart failure, weight gain, and possibly bladder cancer. Most diabetes experts choose a type of medication called a GLP-1 agonist, such as semaglutide, in people with diabetes who do not reach their blood sugar control goals with metformin alone. GLP-1 agonists show benefit in helping people lose weight and have also demonstrated the ability to reduce heart disease risk.
Unfortunately, these types of drugs are much more expensive, and there have been recent shortages due to their use as weightloss drugs.
DEAR DR. ROACH » I understand that there is some research indicating that PSA scores have risen for men who have had a COVID infection and/or a vaccine. Are you aware of this?
DEAR M.S. » I am now. I read a 2022 study following 91 men who had received a
PSA test (a blood test used to screen for prostate cancer and to monitor people with prostate cancer) between three and six months before getting a COVID infection, and were then retested three months after the active COVID infection. The average PSA levels were 1.6 before COVID, 4.3 during COVID, and 2.1 after COVID infection, showing very clearly that the prostate can also be affected by COVID infection.
Men should probably not get a PSA screening during or immediately after the time of COVID infection, but men should certainly still come in for their regular PSA tests. Many men have yet to come back to their doctors for regular checkups after the severe pandemic. However, I could not find any definitive evidence that the blood PSA is affected by any of the available vaccines.
We have seen that lymph nodes under the breast can be temporarily enlarged on the same side that the person received their mammogram — reflecting a general increase in inflammatory response to the vaccine. But the prostate is far away from the injection site, and I think it unlikely that there is a significant change in PSA level following vaccination.
Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.
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