Metformin Transdermal for Diabetic Patients Unable to Tolerate Oral Metformin

Transdermal metformin has been studied as an alternative treatment in patients with insulin resistance who are unable to tolerate oral medications. One advantage of using transdermal metformin is that it bypasses the gastrointestinal system, and therefore does not produce the gastrointestinal side effects associated with oral metformin. Transdermal metformin is dosed at only 5-10% of the typical oral dose, and this significantly reduced actual dose has achieved effects that are clinically comparable to the typical oral dose. Reduced incidence of adverse effects has improved compliance and tolerability for patients who have difficulty swallowing oral agents.

In clinical use of transdermal delivery of metformin formulated with Pluronic Lecithin Organogel (PLO), it was observed that approximately 5-10% of the amount of the usual oral dose elicited a therapeutic response in terms of decreased blood-glucose levels. Transdermal metformin is recommended only for patients with stable, controlled blood sugar and optimized HgA1C levels.

Int J Pharm Pharm Sci, Vol 4, Suppl 3, 297-302
Preparation and evaluation of transdermal patches of metformin hydrochloride using natural polymer for sustained release
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“Psychological stress decreases insulin sensitivity and increases insulin resistance and may hence be important in the development/onset of type I diabetes.”

Neuroimmunomodulation. 2006;13(5-6):301-8. Epub 2007 Aug 6.
Psychological stress and the risk of diabetes-related autoimmunity: a review article.
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“In patients with glucose intolerance, cortisol secretion, although normal, is inappropriately high given enhanced central and peripheral sensitivity to glucocorticoids……thus altered cortisol action occurs not only in obesity and hypertension but also in glucose intolerance and could therefore contribute to the link between these multiple cardiovascular risk factors.”

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Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance.
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