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<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>On the advice of Di Howard I have been
using the 2g Metformin mane regime for 4 years now with all the other tablets
at breakfast and the compliance seems reasonable. I have 93 diabetics and they
are all on once a day medication, as are all the chronic patients. A couple
have complained that the 2g Metformin is a bit rough on their stomach and makes
them feel unwell or sleepy and they know they can take the 2<sup>nd</sup> Metformin
later if they want to. Tim<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><b><font size=2 face=Tahoma><span lang=EN-US
style='font-size:10.0pt;font-family:Tahoma;font-weight:bold'>From:</span></font></b><font
size=2 face=Tahoma><span lang=EN-US style='font-size:10.0pt;font-family:Tahoma'>
carpa-bounces@ozdocit.org [mailto:carpa-bounces@ozdocit.org] <b><span
style='font-weight:bold'>On Behalf Of </span></b>MichaelW.Nixon@nt.gov.au<br>
<b><span style='font-weight:bold'>Sent:</span></b> Thursday, April 19, 2007
9:25 AM<br>
<b><span style='font-weight:bold'>To:</span></b> <st1:PersonName w:st="on">Central
Australian Rural Practitioners Association</st1:PersonName><br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [CARPA] Fwd: Re:
swapping to Metformin XR</span></font><span lang=EN-US><o:p></o:p></span></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><br>
</span></font><font size=2 face=sans-serif><span style='font-size:10.0pt;
font-family:sans-serif'>I am finding such a lot of non-compliance amongst the
Aboriginal diabetic population and I'm slowly changing all my patients over to
SR metformin (up to 2gms) in the hope that there may be more compliance by a
once daily dose in the morning - to be had with their weetbix or porridge! - So
far seems to be working. Just watch the Kidneys! - Mike.</span></font> <br>
<br>
<font size=2 face=sans-serif><span style='font-size:10.0pt;font-family:sans-serif'>Dr
Michael W Nixon<br>
DMO Reg. Rm 126, Block 4, RDH<br>
(Chair MSHR, Ethics Research Committee)<br>
<st1:address w:st="on"><st1:Street w:st="on">Box</st1:Street> 40596</st1:address><br>
CASUARINA NT 0811<br>
Ph 892 28358 Mob 0427 618 915<br>
</span></font><br>
<br>
<o:p></o:p></p>
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<p class=MsoNormal><b><font size=1 face=sans-serif><span style='font-size:
7.5pt;font-family:sans-serif;font-weight:bold'>"Alex Hope"
<wombat@octa4.net.au></span></font></b><font size=1 face=sans-serif><span
style='font-size:7.5pt;font-family:sans-serif'> </span></font><br>
<font size=1 face=sans-serif><span style='font-size:7.5pt;font-family:sans-serif'>Sent
by: carpa-bounces@ozdocit.org</span></font> <o:p></o:p></p>
<p><font size=1 face=sans-serif><span style='font-size:7.5pt;font-family:
sans-serif'>18/04/2007 09:36 PM</span></font> <o:p></o:p></p>
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<p class=MsoNormal align=center style='text-align:center'><font size=1
face=sans-serif><span style='font-size:7.5pt;font-family:sans-serif'>Please
respond to<br>
<st1:PersonName w:st="on">Central Australian Rural Practitioners Association</st1:PersonName>
<carpa@ozdocit.org></span></font><o:p></o:p></p>
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<p class=MsoNormal align=right style='text-align:right'><font size=1
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<p class=MsoNormal><font size=1 face=sans-serif><span style='font-size:
7.5pt;font-family:sans-serif'>carpa@ozdocit.org</span></font> <o:p></o:p></p>
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<p class=MsoNormal align=right style='text-align:right'><font size=1
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<p class=MsoNormal align=right style='text-align:right'><font size=1
face=sans-serif><span style='font-size:7.5pt;font-family:sans-serif'>Subject</span></font><o:p></o:p></p>
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<p class=MsoNormal><font size=1 face=sans-serif><span style='font-size:
7.5pt;font-family:sans-serif'>[CARPA] Fwd: Re: swapping to Metformin XR</span></font><o:p></o:p></p>
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<p class=MsoNormal style='margin-bottom:12.0pt'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><br>
<br>
<br>
</span></font><tt><font size=2 face="Courier New"><span style='font-size:10.0pt'>Would
be good to have input from a few more people on this topic.</span></font></tt><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-family:"Courier New"'><br>
<tt><font face="Courier New">I haven't tried it with any of my patients yet.</font></tt><br>
<tt><font face="Courier New">Alex</font></tt><br>
<tt><font face="Courier New">(scroll down for email exchange)</font></tt><br>
<tt><font face="Courier New">Dr Alex Hope</font></tt><br>
<br>
<tt><font face="Courier New">Community GP,</font></tt><br>
<tt><font face="Courier New">Ltyentye Apurte Community Government Council
Health Centre,</font></tt><br>
<tt><font face="Courier New">CMB Santa Teresa,</font></tt><br>
<tt><font face="Courier New">via <st1:place w:st="on">Alice Springs</st1:place>,</font></tt><br>
<tt><font face="Courier New">NT 0872.</font></tt><br>
<br>
<tt><font face="Courier New">Ph 08 8956 0911</font></tt><br>
<tt><font face="Courier New">Fax 08 8956 0910</font></tt><br>
<tt><font face="Courier New">Mobile 0408 085 143</font></tt><br>
<br>
<br>
<br>
<tt><font face="Courier New">PLUG FOR THE CARPA LIST SERVER</font></tt><br>
<br>
<tt><font face="Courier New">The CARPA list server aims to foster networking
and discussion between health professionals working throughout <st1:country-region
w:st="on"><st1:place w:st="on">Australia</st1:place></st1:country-region>,
particularly in isolated situations and/or Aboriginal health.</font></tt><br>
<tt><font face="Courier New">To see the collection of prior postings to the
list, visit the CARPA Archives here:</font></tt><br>
<br>
<tt><font face="Courier New">http://ozdocit.org/pipermail/carpa/</font></tt><br>
<br>
<tt><font face="Courier New">To sign up for the CARPA discussion emails go
here:</font></tt><br>
<br>
<tt><font face="Courier New">http://ozdocit.org/cgi-bin/mailman/listinfo/carpa</font></tt><br>
<br>
<tt><font face="Courier New">For more information about CARPA in general go
here:</font></tt><br>
<br>
<tt><font face="Courier New">www.carpa.org.au</font></tt><br>
<br>
<br>
<tt><font face="Courier New">***********Here Followeth a Forwarded
Message***********</font></tt><br>
<br>
<tt><font face="Courier New">On 18/04/2007 at 8:18 PM Ciara.OSullivan@nt.gov.au
<Ciara.OSullivan@nt.gov.au> wrote:</font></tt><br>
<br>
<tt><font face="Courier New">>Hi there</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>The recommended maximum dose of metformin XR
is 2 g daily, which is pretty</font></tt><br>
<tt><font face="Courier New">>much in line with the total dose of standard
metformin we are mostly using</font></tt><br>
<tt><font face="Courier New">>now.</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>Ideally metformin XR is taken nocte ... but
this is not very practical and</font></tt><br>
<tt><font face="Courier New">>I think we just have to compromise over this
detail.</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>Cheers - Ciara</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>-----Christine Connors/THS/NTG wrote: -----</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>To: Ciara O'Sullivan/THS/NTG@NTGeMAG</font></tt><br>
<tt><font face="Courier New">>From: Christine Connors/THS/NTG</font></tt><br>
<tt><font face="Courier New">>Date: 04/16/2007 10:01AM</font></tt><br>
<tt><font face="Courier New">>cc: Alan Evans/THS/NTG@NTGeMAG, Heinz
Deiter/THS/NTG@NTGeMAG, John</font></tt><br>
<tt><font face="Courier New">>Hester/THS/NTG@NTGeMAG, Louise
Elliott/THS/NTG@NTGeMAG, Nick</font></tt><br>
<tt><font face="Courier New">>Tyllis/THS/NTG@NTGeMAG,
russell.thompson@wynhealth.org.au, Stephen</font></tt><br>
<tt><font face="Courier New">>Brady/THS/NTG@NTGeMAG, Stephen
Foster/THS/NTG@NTGeMAG, wombat@octa4.net.au</font></tt><br>
<tt><font face="Courier New">>Subject: Re: swapping to Metformin XR</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>so what is other people's experience</font></tt><br>
<tt><font face="Courier New">>will patients take the 4 tabs to make 2gm
daily or do they prefer the</font></tt><br>
<tt><font face="Courier New">>usual 1gm bd?</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Ciara: apart from the obvious issue of big
tablets, is there any issues</font></tt><br>
<tt><font face="Courier New">>taking metformin XR as 3gm single daily dose?</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Dr. Christine Connors</font></tt><br>
<tt><font face="Courier New">>Program Director PCD</font></tt><br>
<tt><font face="Courier New">>NT Department of Health & Community
Services</font></tt><br>
<tt><font face="Courier New">>Phone: (08) 8922 8218</font></tt><br>
<tt><font face="Courier New">>Fax: (08) 8922 7714</font></tt><br>
<tt><font face="Courier New">><st1:City w:st="on"><st1:place w:st="on">Mobile</st1:place></st1:City>:
0401 116 121</font></tt><br>
<tt><font face="Courier New">>email: christine.connors@nt.gov.au</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">> Ciara O'Sullivan/THS/NTG</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Ciara O'Sullivan/THS/NTG </font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>14/04/2007 07:31 PM</font></tt><br>
<tt><font face="Courier New">>To</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Alan Evans/THS/NTG@NTGeMAG, Stephen
Foster/THS/NTG@NTGeMAG, John</font></tt><br>
<tt><font face="Courier New">>Hester/THS/NTG@NTGeMAG, Louise
Elliott/THS/NTG@NTGeMAG, Nick</font></tt><br>
<tt><font face="Courier New">>Tyllis/THS/NTG@NTGeMAG, Heinz
Deiter/THS/NTG@NTGeMAG,</font></tt><br>
<tt><font face="Courier New">>russell.thompson@wynhealth.org.au</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>cc</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Christine Connors/THS/NTG@NTGeMAG,
wombat@octa4.net.au, Stephen</font></tt><br>
<tt><font face="Courier New">>Brady/THS/NTG@NTGeMAG</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Subject</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Re: swapping to Metformin XR</font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">></font></tt><br>
<tt><font face="Courier New">>Hi team</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>Metformin XR is now available in most remote
clinics.</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>I would like to emphasise that metformin XR
and standard metformin 500 mg</font></tt><br>
<tt><font face="Courier New">>tablets are equivalent and when swapping from
a usual treatment dose of</font></tt><br>
<tt><font face="Courier New">>standard metformin of 1 g bd, you need to
prescribe metformin XR 4 tablets</font></tt><br>
<tt><font face="Courier New">>daily. No down-titration is needed with
subsequent up-titration.</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>YES!!! The metformin XR tablets are pretty big
and are actually the same</font></tt><br>
<tt><font face="Courier New">>size (but bulkier) than metformin 1 g tablets.
You need to show the</font></tt><br>
<tt><font face="Courier New">>patients what they are getting as some
patients are horrified and refuse</font></tt><br>
<tt><font face="Courier New">>to swap. </font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>I think using metformin XR in usual treatment
doses of 2 g per day is very</font></tt><br>
<tt><font face="Courier New">>useful for patients on few other tablets.
However use of metformin XR</font></tt><br>
<tt><font face="Courier New">>poses some real problems for us as clinicians;
on the one hand we want to</font></tt><br>
<tt><font face="Courier New">>provide convenient once daily medications
(improves compliance) but on the</font></tt><br>
<tt><font face="Courier New">>other hand, prescribing 4 whoppers in addition
to a handful of other</font></tt><br>
<tt><font face="Courier New">>morning medications is very off putting for
many patients (reduces</font></tt><br>
<tt><font face="Courier New">>compliance).</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>This is the doctors' s dilemma. However, the
solution is not to prescribe</font></tt><br>
<tt><font face="Courier New">>half the previous standard dose of meformin
(ie swapping from metfrormin 1</font></tt><br>
<tt><font face="Courier New">>g bd to metformin XR 1 g od) which potentially
deprives the patient of</font></tt><br>
<tt><font face="Courier New">>useful treatment, and this is what I am seeing
on a lot of the scripts at</font></tt><br>
<tt><font face="Courier New">>the moment!</font></tt><br>
<tt><font face="Courier New">> </font></tt><br>
<tt><font face="Courier New">>Cheers - CIara</font></tt><br>
<br>
<tt><font face="Courier New">*********** END FORWARDED MESSAGE
***********</font></tt><br>
<tt><font face="Courier New">_______________________________________________</font></tt><br>
<tt><font face="Courier New">CARPA mailing list</font></tt><br>
<tt><font face="Courier New">CARPA@ozdocit.org</font></tt><br>
<tt><font face="Courier New">http://ozdocit.org/cgi-bin/mailman/listinfo/carpa</font></tt></span></font><o:p></o:p></p>
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