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PEARL DROP: With SGAs, How Often Is Metformin Actually Used? · Pearls and Prep

• 0:00
  Foreign.
• 0:04
  Welcome
• 0:04
  back,
• 0:05
  my
• 0:05
  friends,
• 0:05
  to
• 0:06
  a
• 0:07
  bonus
• 0:07
  episode
• 0:08
  of
• 0:08
  Pearls
• 0:09
  and
• 0:09
  Prep.
• 0:09
  This
• 0:10
  is
• 0:10
  your
• 0:10
  Monday
• 0:11
  Pearl
• 0:11
  Drop.
• 0:12
  Hope
• 0:12
  you
• 0:12
  enjoy
• 0:13
  it.
• 0:13
  Spread
• 0:13
  the
• 0:13
  love.
• 0:14
  Share
• 0:14
  this
• 0:14
  with
• 0:14
  other
• 0:15
  people.
• 0:15
  This
• 0:15
  is
• 0:15
  a
• 0:15
  doozy.
• 0:16
  It's
• 0:16
  definitely
• 0:17
  one
• 0:17
  we
• 0:17
  need
• 0:17
  to
• 0:18
  think
• 0:18
  about
• 0:18
  and
• 0:18
  meditate
• 0:19
  about.
• 0:20
  So
• 0:20
  here
• 0:20
  goes.
• 0:21
  Without
• 0:21
  further
• 0:21
  ado,
• 0:22
  the
• 0:22
  question
• 0:23
  is
• 0:23
  this
• 0:23
  among
• 0:24
  patients
• 0:24
  prescribed
• 0:25
  second
• 0:25
  generation
• 0:26
  antipsychotics
• 0:27
  who
• 0:28
  meet
• 0:28
  criteria
• 0:28
  for
• 0:29
  metformin
• 0:29
  co
• 0:29
  prescription,
• 0:30
  approximately
• 0:31
  what
• 0:31
  percentage
• 0:32
  actually
• 0:33
  receive
• 0:33
  the
• 0:33
  metformin?
• 0:34
  Is
• 0:34
  it
• 0:35
  A,
• 0:35
  25%,
• 0:36
  B,
• 0:37
  15%,
• 0:38
  C,
• 0:39
  10%
• 0:40
  or
• 0:40
  D2
• 0:41
  to
• 0:41
  3%?
• 0:42
  Give
• 0:43
  it
• 0:43
  a
• 0:43
  moment,
• 0:44
  Maybe
• 0:44
  pause
• 0:44
  this
• 0:45
  if
• 0:45
  you
• 0:45
  don't
• 0:45
  want
• 0:45
  a
• 0:46
  spoiler.
• 0:47
  Ask
• 0:47
  your
• 0:47
  colleagues
• 0:48
  how
• 0:48
  often
• 0:48
  they
• 0:48
  prescribe
• 0:49
  Metformin.
• 0:50
  Ask
• 0:50
  your
• 0:51
  teachers,
• 0:52
  ask
• 0:52
  around.
• 0:53
  Ask
• 0:53
  how
• 0:54
  much
• 0:54
  you
• 0:54
  prescribe
• 0:54
  Metformin.
• 0:55
  Well,
• 0:56
  my
• 0:56
  friends,
• 0:56
  the
• 0:56
  answer
• 0:57
  without
• 0:57
  further
• 0:57
  ado
• 0:58
  is
• 0:58
  D2
• 0:59
  to
• 0:59
  3%.
• 1:00
  Yes,
• 1:00
  that
• 1:00
  is
• 1:01
  a
• 1:01
  shocker
• 1:02
  to
• 1:02
  me.
• 1:02
  Kind
• 1:03
  of
• 1:03
  a
• 1:03
  catastrophic
• 1:04
  statistic.
• 1:04
  A
• 1:04
  come
• 1:05
  to
• 1:05
  Jesus
• 1:05
  moment
• 1:06
  for
• 1:06
  all
• 1:06
  clinicians
• 1:07
  everywhere,
• 1:09
  worldwide.
• 1:09
  We
• 1:09
  need
• 1:10
  to
• 1:10
  really
• 1:10
  look
• 1:10
  at
• 1:11
  this
• 1:11
  and
• 1:11
  ask
• 1:11
  ourselves
• 1:12
  why
• 1:12
  we
• 1:12
  are
• 1:12
  under
• 1:13
  prescribing
• 1:13
  Metformin.
• 1:14
  This
• 1:15
  is
• 1:15
  coming
• 1:15
  from
• 1:15
  a
• 1:16
  study
• 1:16
  out
• 1:16
  of
• 1:16
  the
• 1:16
  Lancet
• 1:17
  in
• 1:17
  2025
• 1:19
  where
• 1:20
  they
• 1:20
  studied
• 1:20
  30,000
• 1:21
  youth
• 1:21
  treated
• 1:22
  with
• 1:22
  second
• 1:22
  generation
• 1:23
  antipsychotics
• 1:24
  and
• 1:24
  only
• 1:24
  677
• 1:25
  of
• 1:25
  them,
• 1:25
  or
• 1:26
  2.3%,
• 1:27
  were
• 1:27
  co
• 1:27
  prescribed
• 1:28
  metformin
• 1:28
  in
• 1:29
  the
• 1:29
  last
• 1:29
  30
• 1:29
  days.
• 1:30
  Well,
• 1:30
  that's
• 1:30
  a
• 1:30
  shocker
• 1:31
  because
• 1:31
  we
• 1:31
  know
• 1:32
  metformin
• 1:32
  is
• 1:33
  reliably
• 1:34
  good
• 1:35
  at
• 1:35
  helping
• 1:36
  you
• 1:36
  lose
• 1:36
  weight,
• 1:37
  helping
• 1:38
  you
• 1:38
  not
• 1:38
  gain
• 1:38
  more
• 1:39
  weight.
• 1:39
  The
• 1:39
  evidence
• 1:40
  shows
• 1:40
  something
• 1:41
  like
• 1:41
  £7.3
• 1:42
  for
• 1:42
  some
• 1:43
  people.
• 1:43
  Of
• 1:43
  course,
• 1:43
  give
• 1:43
  or
• 1:44
  take,
• 1:44
  there's
• 1:44
  BMI
• 1:45
  reductions.
• 1:46
  We
• 1:46
  know
• 1:46
  that
• 1:47
  it's
• 1:47
  helpful
• 1:48
  in
• 1:48
  diabetes
• 1:49
  prevention.
• 1:50
  And
• 1:51
  so
• 1:51
  it
• 1:52
  can
• 1:52
  have
• 1:52
  a
• 1:52
  really
• 1:52
  favorable
• 1:53
  effect
• 1:53
  on
• 1:54
  your
• 1:54
  A1C
• 1:55
  and
• 1:55
  your
• 1:55
  fasting
• 1:56
  blood
• 1:56
  glucose
• 1:57
  and
• 1:57
  your
• 1:58
  BMI
• 1:58
  and
• 1:58
  your
• 1:58
  triglycerides.
• 1:59
  So
• 2:00
  why
• 2:00
  are
• 2:00
  we
• 2:01
  not
• 2:01
  prescribing
• 2:02
  this
• 2:02
  more
• 2:02
  is
• 2:03
  a
• 2:03
  great
• 2:03
  question
• 2:03
  and
• 2:03
  we're
• 2:04
  gonna
• 2:04
  do
• 2:04
  a
• 2:04
  whole
• 2:04
  episode
• 2:05
  on
• 2:05
  that
• 2:05
  very
• 2:06
  soon.
• 2:06
  But
• 2:06
  this
• 2:06
  was
• 2:07
  just
• 2:07
  a
• 2:07
  quick
• 2:07
  pearl
• 2:08
  drop
• 2:08
  for
• 2:08
  you
• 2:09
  to
• 2:09
  really
• 2:09
  consider
• 2:10
  that
• 2:10
  we
• 2:10
  are
• 2:10
  radically
• 2:11
  underprescribing
• 2:13
  Metformin
• 2:13
  and
• 2:13
  antipsychotics
• 2:14
  can
• 2:14
  save
• 2:15
  lives.
• 2:15
  They
• 2:16
  are
• 2:16
  fantastically
• 2:17
  good.
• 2:17
  I
• 2:18
  mean,
• 2:18
  to
• 2:18
  think
• 2:18
  that
• 2:18
  we
• 2:18
  even
• 2:19
  have
• 2:19
  a
• 2:19
  medication
• 2:19
  out
• 2:20
  there
• 2:20
  that
• 2:20
  can
• 2:21
  silence
• 2:21
  a
• 2:21
  voice
• 2:22
  that
• 2:22
  is
• 2:23
  urging
• 2:23
  you
• 2:23
  to
• 2:23
  hurt
• 2:23
  yourself
• 2:24
  or
• 2:25
  taunting
• 2:25
  you
• 2:25
  on
• 2:25
  a
• 2:26
  daily
• 2:26
  basis.
• 2:26
  Right.
• 2:26
  These
• 2:27
  are
• 2:27
  life
• 2:28
  changing
• 2:28
  medications
• 2:29
  in
• 2:29
  some
• 2:29
  cases.
• 2:30
  But
• 2:30
  we
• 2:31
  can't
• 2:31
  forget
• 2:32
  that
• 2:32
  the
• 2:32
  number
• 2:32
  one
• 2:33
  cause
• 2:33
  of
• 2:33
  death
• 2:34
  in
• 2:34
  patients
• 2:35
  with
• 2:35
  severe
• 2:35
  mental
• 2:36
  illness
• 2:36
  is
• 2:36
  not
• 2:36
  suicide.
• 2:38
  It's
• 2:38
  not
• 2:38
  command
• 2:39
  hallucinations.
• 2:40
  Right.
• 2:40
  It's
• 2:40
  actually
• 2:41
  cardiovascular
• 2:42
  disease.
• 2:42
  Right.
• 2:42
  And
• 2:43
  so,
• 2:43
  I
• 2:44
  mean,
• 2:44
  how
• 2:44
  many
• 2:44
  times
• 2:44
  have
• 2:44
  you
• 2:45
  met
• 2:45
  a
• 2:45
  patient
• 2:45
  who's
• 2:46
  on
• 2:46
  a
• 2:46
  antipsychotic
• 2:47
  and
• 2:48
  their
• 2:48
  BMI
• 2:49
  is
• 2:49
  increasing,
• 2:50
  they're
• 2:50
  gaining
• 2:50
  weight,
• 2:51
  they,
• 2:52
  their
• 2:52
  triglycerides,
• 2:53
  their
• 2:53
  lipid
• 2:53
  panel,
• 2:54
  everything's
• 2:54
  just
• 2:54
  exploding.
• 2:55
  So
• 2:56
  that
• 2:56
  alone
• 2:56
  can
• 2:57
  cause
• 2:57
  cardiovascular
• 2:58
  disease.
• 2:58
  Our
• 2:58
  patients
• 2:58
  are
• 2:59
  more
• 2:59
  likely
• 2:59
  to
• 2:59
  smoke
• 3:00
  because
• 3:00
  they're
• 3:00
  stressed.
• 3:00
  When
• 3:01
  you're
• 3:01
  in
• 3:01
  Fight
• 3:01
  or
• 3:01
  flight
• 3:02
  and
• 3:02
  your
• 3:02
  cortisol's
• 3:03
  shooting
• 3:03
  through
• 3:03
  your
• 3:04
  veins
• 3:04
  all
• 3:04
  day,
• 3:05
  of
• 3:05
  course
• 3:05
  that's
• 3:05
  neurotoxic.
• 3:06
  It
• 3:06
  can
• 3:07
  cause
• 3:07
  weight
• 3:07
  gain,
• 3:08
  it
• 3:08
  can
• 3:08
  dysregulate
• 3:08
  your
• 3:09
  blood
• 3:09
  sugar
• 3:09
  just
• 3:10
  having
• 3:11
  like
• 3:11
  a
• 3:11
  dysregulated
• 3:12
  HPA
• 3:13
  axis.
• 3:13
  So
• 3:14
  again,
• 3:14
  there
• 3:14
  is
• 3:14
  so
• 3:15
  much
• 3:15
  metabolic
• 3:16
  damage
• 3:17
  that
• 3:17
  is
• 3:18
  exacted
• 3:18
  on
• 3:18
  mental
• 3:19
  health
• 3:19
  patients
• 3:19
  in
• 3:20
  particular.
• 3:20
  And
• 3:20
  yet
• 3:21
  we
• 3:21
  have
• 3:21
  this
• 3:21
  low
• 3:21
  hanging
• 3:22
  fruit,
• 3:22
  super
• 3:23
  cheap
• 3:23
  medication
• 3:24
  too,
• 3:24
  by
• 3:24
  the
• 3:24
  way,
• 3:24
  generically,
• 3:25
  it's
• 3:25
  like
• 3:25
  $4
• 3:26
  a
• 3:27
  month.
• 3:27
  No
• 3:28
  prior
• 3:28
  authorization,
• 3:28
  no
• 3:29
  REMs,
• 3:29
  no
• 3:30
  monitoring
• 3:30
  program,
• 3:30
  no
• 3:31
  abuse
• 3:31
  potential.
• 3:32
  You
• 3:32
  know,
• 3:32
  generic
• 3:33
  metformin,
• 3:34
  er,
• 3:35
  sure
• 3:35
  there's
• 3:36
  side
• 3:36
  effects,
• 3:36
  sure
• 3:36
  there's
• 3:36
  things
• 3:37
  that,
• 3:37
  you
• 3:37
  know,
• 3:38
  we
• 3:38
  need
• 3:38
  to
• 3:38
  be
• 3:38
  careful
• 3:39
  about.
• 3:39
  And
• 3:39
  we
• 3:39
  can
• 3:40
  definitely
• 3:40
  go
• 3:40
  over
• 3:40
  those
• 3:40
  in
• 3:41
  our
• 3:41
  episode
• 3:42
  coming
• 3:42
  up
• 3:42
  on
• 3:42
  Metformin.
• 3:43
  If
• 3:44
  you're
• 3:44
  a
• 3:44
  Patreon
• 3:45
  member,
• 3:45
  just
• 3:45
  kind
• 3:46
  of
• 3:46
  putting
• 3:46
  a
• 3:46
  little
• 3:46
  plug
• 3:46
  here,
• 3:47
  you'll
• 3:47
  get
• 3:47
  an
• 3:47
  early
• 3:48
  episode
• 3:48
  drop
• 3:49
  and
• 3:50
  you'll
• 3:50
  really
• 3:50
  understand
• 3:51
  the
• 3:51
  how
• 3:51
  and
• 3:52
  the
• 3:52
  why
• 3:53
  of
• 3:53
  metformin.
• 3:54
  And
• 3:54
  you'll
• 3:54
  understand
• 3:54
  the
• 3:55
  how
• 3:55
  and
• 3:55
  the
• 3:55
  why
• 3:55
  of
• 3:55
  so
• 3:56
  many
• 3:56
  different
• 3:56
  medications
• 3:57
  and
• 3:57
  so
• 3:57
  many
• 3:58
  different
• 3:58
  diagnoses.
• 3:59
  And
• 3:59
  that's
• 3:59
  really
• 4:00
  what's
• 4:00
  going
• 4:00
  to
• 4:00
  separate
• 4:00
  you
• 4:01
  from
• 4:01
  the
• 4:01
  good
• 4:01
  and
• 4:01
  the
• 4:01
  great
• 4:02
  clinicians.
• 4:02
  If
• 4:02
  you
• 4:02
  go
• 4:03
  to
• 4:03
  our
• 4:03
  show
• 4:03
  notes
• 4:04
  and
• 4:04
  become
• 4:04
  a
• 4:04
  Patreon
• 4:05
  member.
• 4:05
  If
• 4:05
  there's
• 4:06
  one
• 4:06
  thing
• 4:06
  you
• 4:06
  gotta
• 4:07
  put
• 4:07
  on
• 4:07
  your
• 4:07
  to
• 4:07
  do
• 4:07
  list
• 4:08
  today,
• 4:08
  it's
• 4:08
  to
• 4:08
  go
• 4:08
  to
• 4:09
  our
• 4:09
  Patreon
• 4:09
  show
• 4:09
  notes
• 4:10
  and
• 4:10
  become
• 4:10
  a
• 4:10
  member.
• 4:10
  Because
• 4:11
  patients
• 4:12
  can
• 4:12
  smell
• 4:12
  you
• 4:12
  a
• 4:13
  mile
• 4:13
  away
• 4:13
  between
• 4:14
  a
• 4:14
  prescriber
• 4:15
  that
• 4:15
  just
• 4:15
  prescribes
• 4:16
  based
• 4:16
  on
• 4:16
  algorithms
• 4:17
  and
• 4:17
  one
• 4:18
  that
• 4:18
  actually
• 4:18
  has
• 4:19
  the
• 4:20
  know
• 4:20
  how
• 4:21
  of
• 4:21
  the
• 4:21
  how
• 4:22
  and
• 4:22
  why
• 4:23
  and
• 4:23
  can
• 4:23
  explain
• 4:23
  it
• 4:24
  to
• 4:24
  a
• 4:24
  patient
• 4:24
  patiently.
• 4:25
  But
• 4:25
  yes,
• 4:25
  Metformin,
• 4:26
  low
• 4:26
  hanging
• 4:27
  fruit.
• 4:27
  2
• 4:27
  to
• 4:27
  3%
• 4:28
  are
• 4:28
  prescribing
• 4:29
  this
• 4:30
  with
• 4:30
  their
• 4:30
  antipsychotics.
• 4:31
  That
• 4:31
  is
• 4:31
  radically
• 4:32
  low.
• 4:33
  It
• 4:33
  can
• 4:33
  really
• 4:33
  help.
• 4:34
  We're
• 4:34
  going
• 4:35
  to
• 4:35
  talk
• 4:35
  a
• 4:35
  dosing
• 4:36
  in
• 4:36
  our
• 4:37
  new
• 4:37
  episode.
• 4:37
  We're
• 4:38
  going
• 4:38
  to
• 4:38
  talk
• 4:38
  about
• 4:38
  side
• 4:39
  effects,
• 4:39
  things
• 4:39
  you
• 4:39
  have
• 4:40
  to
• 4:40
  monitor.
• 4:40
  Just
• 4:40
  practical
• 4:41
  pearls.
• 4:41
  And
• 4:42
  we're
• 4:42
  going
• 4:42
  to
• 4:42
  also
• 4:42
  go
• 4:42
  into
• 4:43
  the
• 4:43
  why
• 4:43
  people
• 4:44
  are
• 4:44
  not
• 4:44
  prescribing
• 4:45
  this
• 4:46
  right.
• 4:46
  A
• 4:46
  lot
• 4:46
  of
• 4:46
  times
• 4:46
  it's
• 4:47
  just
• 4:47
  prescribers
• 4:48
  forget,
• 4:48
  they
• 4:49
  don't
• 4:49
  even
• 4:49
  think
• 4:49
  about
• 4:49
  it
• 4:50
  or
• 4:50
  they're
• 4:50
  uncomfortable
• 4:51
  because
• 4:51
  they
• 4:51
  think
• 4:51
  it's
• 4:52
  not
• 4:52
  in
• 4:53
  their
• 4:53
  lane.
• 4:53
  And
• 4:54
  not
• 4:54
  even
• 4:54
  realizing
• 4:54
  that
• 4:55
  patients
• 4:55
  don't
• 4:55
  always
• 4:55
  have
• 4:55
  a
• 4:56
  primary
• 4:56
  care
• 4:56
  provider
• 4:57
  to
• 4:57
  begin
• 4:57
  with.
• 4:57
  So
• 4:58
  we
• 4:58
  going
• 4:58
  to
• 4:58
  go
• 4:58
  much
• 4:58
  deeper
• 4:59
  into
• 4:59
  that.
• 4:59
  Please
• 4:59
  share
• 5:00
  this.
• 5:00
  Pearl.
• 5:00
  It's
• 5:00
  a
• 5:00
  doozy.
• 5:01
  It's
• 5:01
  a
• 5:01
  really.
• 5:02
  This
• 5:02
  is
• 5:02
  a
• 5:03
  big
• 5:03
  deal
• 5:04
  and,
• 5:04
  you
• 5:04
  know,
• 5:05
  we.
• 5:05
  We've
• 5:05
  got
• 5:05
  to
• 5:05
  intervene
• 5:06
  here.
• 5:06
  We've
• 5:06
  got
• 5:06
  to
• 5:07
  make
• 5:07
  Metformin
• 5:07
  more
• 5:08
  friendly
• 5:08
  and
• 5:08
  we've
• 5:08
  got
• 5:08
  to
• 5:09
  have
• 5:09
  more
• 5:09
  conversations
• 5:09
  about
• 5:10
  Metformin,
• 5:11
  less
• 5:11
  talk
• 5:12
  around
• 5:12
  the
• 5:12
  dinner
• 5:13
  table
• 5:13
  about
• 5:13
  politics
• 5:14
  and
• 5:14
  religion
• 5:14
  and
• 5:15
  more
• 5:15
  talk
• 5:16
  about
• 5:16
  the
• 5:16
  virtues
• 5:17
  of
• 5:17
  Metformin.
• 5:18
  Thank
• 5:18
  you.
• 5:19
  Bye.
• 5:19
  Bye.