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J Res Med Sci. 2014 Jul; 19(7): 658–664. 

PMCID: PMC4214027

PMID: 25364368

Metformin: Current knowledge

Hamid Nasri and Mahmoud Rafieian-Kopaei1

Author informationArticle notesCopyright and License informationPMC Disclaimer

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Abstract

Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces sever complications. Metformin drug has been shown to prevent diabetes in people who are at high risk and decrease most of the diabetic complications. Recent reports on metformin, not only indicate some implications such as renoprotective properties have been suggested for metformin, but some reports indicate its adverse effects as well that are negligible when its benefits are brought into account. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers.

Keywords: Diabetes, diabetes mellitus, diabetic nephropathy, glucose, metformin, new applications, polycystic ovary syndrome, renoprotection

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INTRODUCTION

Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces the classical symptoms of polyuria, polydipsia and polyphagia. It may also cause nerve problems, kidney problems, and blindness, loss of limbs, and sexual dysfunction, increase in heart attack or stroke.[1] Metformin (a biguanide derivative), by controlling blood glucose level decreases these complications. Metformin works by helping to restore the body’s response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.[2] Metformin, other than hypoglycemic activity, has been taken with diet and exercise changes to prevent diabetes in people who are at high risk for becoming diabetic. It is also used in women with polycystic ovarian syndrome. Metformin may make menstrual cycles more regular and increase fertility.[3] Metformin was first synthesized and found to decrease the blood glucose level in the 1920s; however, it was not used for a long time. The use of metformin was rekindled in 1957, when the results of a clinical trial were published confirming its effect on diabetes. Metformin is now widely prescribed as an anti-diabetic drug; however, there have been serious concerns about its adverse effects, especially ketoacidosis.[4] Recently, not only some implications have been discovered for metformin, but also there are reports indicating that its adverse effects are negligible when its benefits are brought into account.[3] Theoretically, its use has been prohibited in a large group of patients with type 2 diabetes mellitus due to the risk of lactic acidosis. However, it has been shown that several diabetic patients who are considered to be at risk have received metformin with no increased risk of lactic acidosis.[2,3,4,5] Furthermore, recently some papers have been published indicating renoprotective properties for metformin. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers.

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NEW AND OLD IMPLICATIONS AND THE MECHANISMS OF ACTION

Diabetes mellitus

Metformin is primarily used for the treatment of type 2 diabetes mellitus, particularly in obese.patients. Metformin has been shown to reduce diabetes mortality and complications by thirty percent compared to insulin, glibenclamide and chlorpropamide.[5]

Metformin reduces serum glucose level by several different mechanisms, notably through nonpancreatic mechanisms without increasing insulin secretion. It increases the effects of insulin; hence, it is termed “insulin sensitizer”. Metformin also suppresses the endogenous glucose production by the liver, which is mainly due to a reduction in the rate of gluconeogenesis and a small effect on glycogenolysis. Moreover, metformin activates the enzyme adenosine monophosphate kinase (AMPK) resulting in the inhibition of key enzymes involved in gluconeogenesis and glycogen synthesis in the liver while stimulating insulin signaling and glucose transport in muscles. AMPK regulates the cellular and organ metabolism and any decrease in hepatic energy, leads to the activation of AMPK. This study to an extent has put forth to explain the mechanism of metformin action on liver gluconeogenesis.[6,7]

Furthermore, metformin increases the peripheral glucose disposal that arises largely through increased non-oxidative glucose disposal into skeletal muscle. It usually does not cause hypoglycemia and this cause to be considered as a unique anti-diabetic drug.[8]

Treatment of diabetes with metformin is associated with less weight gain compared with insulin and sulfonylureas. Weight gain helps in better glucose control. In a study it was shown that, over a 10-year treatment period, the patients treated with metformin gained about one kg, the patients treated with glibenclamide gained about three kg, and the patients treated with the insulin gained six kg weight.[9]

Pre-diabetes

The chance of developing type 2 diabetes mellitus may decrease in people at risk for this disease; however, dieting and intensive physical exercise may work significantly better for this purpose. In a large study in the United States, participants were given placebo, lifestyle intervention or metformin, and followed for three years. The lifestyle modifications included a 16-lesson training on exercise and dieting followed by monthly sessions for individuals with the aim of decreasing the body weight by 7%. These patients under this group were engaged in a physical activity for about 150 minutes/week. The incidence of diabetes mellitus in this group was by 58%, and in metformin group by 31%. After ten years, the incidence of the disease was lower by 34% in the patients on diet and exercise and 18% in the metformin group.[10]

Gestational diabetes

Several trials have suggested that metformin is as safe and effective as insulin for the treatment of gestational diabetes,[11] and it has been suggested that the mothers who have used metformin instead of insulin might be healthier in the neonatal period.[12] However, evidence is still lacking on the long term safety of metformin for both children and mothers.[13]

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is frequently associated with resistance to insulin and since 1994, metformin has been proposed as a treatment for PCOS.[14] In 2004, National Institute for Health and Clinical Excellence recommended to prescribe metformin for women with PCOS and a body mass index above 25 for anovulation and infertility when other therapies have failed to produce acceptable results.[15] However, several subsequent reviews did not show promising results and did not recommend it further or at least as a first-line medication,[16] except for women with glucose intolerance.[17] The guidelines usually suggest clomiphene to be the first treatment and recommend lifestyle modification independent from drug therapy.

A systematic review using comparative trials of clomiphene and metformin found equal results for infertility[18] and A BMJ editorial suggested that metformin should be used as a second choice, if clomiphene treatment fails.[19] Furthermore, a large review using 27 clinical trials found that metformin was not associated with any increase in the number of live births; however, it improved ovulation rates, especially when it was used in combination with clomiphene.[20]

Further, a review recommended metformin as a first choice because of positive effects on insulin resistance, hirsutism, anovulation and obesity, which are often associated with polycystic ovary syndrome.[21]

The different trial designs might be the reasons for the contradictory results. For example, considering live birth rate instead of pregnancy as the endpoint might have biased a few trials against metformin.[22] Another explanation is that metformin may have different efficacy in different populations.

Cancer protection

A large case-control study has suggested that metformin might protect patients against pancreatic cancer. In this study, the risk of pancreatic cancer in metformin group was 62% lower than in placebo group who did not use metformin. The participants having sulfonylureas or insulin were found to have a 2.5-fold and 5-fold higher risk of pancreatic cancer, respectively, in comparison to placebo group.[23] Several studies have suggested that diabetic patients using metformin might lower the risk of cancer compared to those using other anti-diabetic drugs.[24,25] However, the results need confirmation in controlled trials.[26]

Metformin has shown a strong antiproliferative effects on colon, pancreatic, breast, ovarian, prostate and lung cancer cells. Preclinical studies have also shown reliable anti-tumoral effects in different animal models. A clinical trial has demonstrated beneficial effect in colon and breast cancers.[27]

The mechanism of this action is not clear. Other anti-diabetic drugs have not shown the same anticancer activities; hence, the anticancer effect of metformin should not be related to anti-diabetic activity of this drug. Metformin possesses antioxidant activity.[28] Antioxidants have been shown to have various beneficial effects such as anticancer,[29,30,31,32] antidiabetes[33] and antiatherosclerosis[34,35] properties. Therefore, some beneficial effects of metformin might be related to its antioxidant activity.

HIV-associated diabetes

The use of some of antiretroviral drugs in HIV-infection has been associated with glucose tolerance, insulin resistance, hyperinsulinemia and type 2 diabetes mellitus. Low HDL, Hypertriglyceridemia and high risk of cardiovascular diseases have been reported in these patients. These metabolic alterations are frequently associated with loss of subcutaneous fat and increased visceral fat.[36,37]

Antiretroviral therapies with protease inhibitors inhibit glucose transporter (GLUT)-4 mediated glucose transport.[38] They are likely to be, in part, responsible for the insulin resistance and body composition changes in HIV-infected patients. Metformin has been shown to reduce visceral adiposity and insulin resistance after 8 weeks of drug therapy at dose of 850 mg, 3 times per day.[39]

Nephrotoxicity prevention

Recent studies have suggested that metformin may have therapeutic or renoprotective effects against nephrotoxic agents.[40,41] It has also been shown to have a good efficacy in diabetic nephropathy.[40,41,42,43,44] Furthermore, it significantly decreases albuminuria in patients with diabetes mellitus.[41,42,43,44] However, the exact mechanism beyond these effects is still unknown. Recent studies have shown that therapeutic effect of metformin is mediated through its action on adenosine monophosphate (AMP)-activated kinase in tissues.[43,44,45,46,47,48] Various studies have shown that metformin is capable of decreasing intracellular reactive oxygen species (ROS).[45,46,47,48,49] It protects tubular injury through regulation of oxidative stress and restoring the biochemical alterations on renal tubules. Metformin may also protect the podocytes in diabetic nephropathy.[47,48,49,50,51]

Various studies have shown that AMPK activation of metformin is secondary to its effect on the mitochondria as the primary target.[52] Recent studies have demonstrated a direct or mediated mitochondrial effect for metformin.[53] When metformin is used alone, its beneficial effect is due to the mild inhibition of the mitochondrial respiration.[54,55]

The effect of mitochondria in programmed cell death is usually associated with the release of apoptotic signaling molecules.[56] Moreover, ROS production by mitochondria may also lead to cell degradation.[57]

Mitochondria represents as one of the major cellular sources of ROS generation,[50] and a great number of tissue pathologies, which induce oxidative stress.[58,59] These findings may show the critical role of mitochondria in these conditions.[58,59]

The nephrotoxicity of aminoglycosides and most of other renotoxic agents has been attributed to ROS.[60] In certain conditions, intracellular ROS may reach a toxic level, resulting in oxidative damage and malfunctioning of the organ.[54]

We conducted a study on male Wistar rats to test the potential properties of metformin in protecting the kidney from gentamicin-induced acute renal failure, and to find out by postponing the treatment with metformin in acute renal failure exerts similar benefits as on gentamicin nephrotoxicity in rats.[61] Metformin not only had preventive effect but also exerted ameliorative activity against gentamicin nephrotoxicity. Hence, it might be beneficial in patients under treatment with this drug.[49]

Metformin has also shown to have beneficial effect on renal function and structure after unilateral ischemia-reperfusion in rats.[62] The authors in this study have concluded that metformin has tissue protection with the activation of endothelial nitric oxide synthase and AMPK.[61]

Various studies have shown that ROS overproduction might be the key starting events, which cause development of complications of diabetes.[63] However, the exact mechanisms that cause hyperglycemia and diabetic nephropathy are not elucidated.[64] It has been shown that nucleic acids can be affected by oxidative stress, thereby modifying the bases in DNA. When DNA is damaged the affected cells start a response such as cell cycle delay, DNA repair or apoptosis induction. ROS generation by oxidative stress causes cell death.[65] Apoptosis is implicated in the pathogenesis of diabetic nephropathy. ROS is an inducer of apoptosis in various cell types including podocytes.[66]

Metformin is able to restore the podocytes in diabetic rats and diabetes-induced podocyte loss in diabetic nephropathy has been attenuated to ROS.[67] Podocyte apoptosis is associated with increased albuminuria. Phosphorylation of AMPK is reduced in the kidney of diabetic rats. Therefore, metformin may exert some of its effects by improving the renal oxidative stress.[67] These findings are in agreement with other studies showing beneficial antioxidant properties of metformin in diabetic rats.[68]

These findings may encourage the clinical use of metformin along with nephrotoxic drugs as well as for prevention of diabetic nephropathy.

Side effects

Metformin has not significant adverse effects; however, it may cause a serious condition called lactic acidosis with the following symptoms: Dizziness, severe drowsiness, muscle pain, tiredness, chills, blue/cold skin, fast/difficult breathing, slow/irregular heartbeat, stomach pain with diarrhea, nausea or vomiting.[1,41,43,69]

Lactic acidosis usually occurs due to drug overdose or in some contraindicated conditions. It is more likely to occur in patients with certain medical conditions, including a serious infection, liver or kidney disease, recent surgery, any conditions that cause a low level of oxygen in the blood or poor circulation (such as recent stroke, congestive heart failure, recent heart attack), heavy alcohol use, dehydration, X-ray or scanning procedures that require an injectable iodinated contrast drug and those older than 80 years.[1,41,43,70]

Nausea, vomiting, stomach upset, diarrhea, weakness, or a metallic taste in the mouth may occur.

Metformin usually does not cause hypoglycemia; however, low blood sugar may occur if this drug is used with other anti-diabetic drugs. Hypoglycemia is more likely to occur with heavy exercise, drinking large amounts of alcohol, or not consuming enough calories from food.

Symptoms of hyperglycemia include polydipsia, polyuria, rapid breathing, flushing, confusion, drowsiness, and fruity breath odor.[1,41,43,71,72]

Serious allergic reaction to this drug is rare; however, this product may contain inactive ingredients, which can cause allergic reactions or other problems. High fever, diarrhea, vomiting, diuretics or excess sweating may cause dehydration and increase the risk of lactic acidosis. Older adults may be at greater risk for side effects such as low blood sugar or lactic acidosis.[1,41,43,62,71]

Gastrointestinal intolerance is one of the most frequently occurred and lactic acidosis is a rare, but causes serious adverse effects.[73,74] Incidence of myocardial infarction (MI) is also an important event but seen less in metformin compared with sulfonylurea agents.[75] Metformin induced lactic acidosis is a rare but important and fatal adverse event.

A population-based study demonstrated that about one-fourth of patients prescribed metformin had contraindications to its use. However, contraindications rarely resulted in discontinuation of metformin usage.[76] These data have been confirmed by several other studies in different countries.[77,78]

Furthermore, in a recent review article, based on 347 observational cohort studies and prospective comparative trials, no evidence indicating metformin to be associated with increased levels of lactate or increased risk of lactic acidosis in comparison to other antihyperglycaemic drugs has been reported.[7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79] It should be noted that in this report, all clinical trials excluded the risk patients. Therefore, the scenario might be rather different, in real population.

In a study sample of 19,691 type 2 diabetes mellitus (DM), patients with established atherothrombosis participating in study, the two-year mortality rate was significantly less in patients treated with metformin compared with the patients not treated with metformin.[80,

Psalm 147:3, And What It Means to All People.

      Good Day Everyone!!  How are you doing today?  Fine, I hope.  I want to inform all of you that Psalms 147:3 is the topic of today.  Psalms 147:3 says; He health the broken in heart, and bindeth up their wounds.  This Bible verse means that God is with all of us.

  He heals our broken hearts, and He bindeth up our wounds.  I want to say that God is my best friend.  God is my Best Friend because He hears my cries, and He smiles at me when I am doing something good.  I know that God rejoices when we do things that pleases Him.

Further, I want to inform all of you that God helped me graduate from college on two occasions.  I want to say that God is responsible for helping me with my bad attitude.  I know this because; His Spirit is inside of me. According to John 14:26, it states that He will give you an Advocate, which is the Holy Spirit to teach you, and put things into your remembrance.

      The Lord is still inside of us.  He is doing for all of us, more than we are doing for ourselves.  I want to inform all of you that everything that is inside of the Holy Bible is the truth.  At least, I can say that it reminds me of the Footprints inside of the Sand. God is really with us at all times. 

I know for me personally, I remember when I used to use vulgarity all of the time.  Right Now, I ask God to remove the bad thoughts that I have inside of my heart.  I know that we have to remember who is in charge right now.  It is not me; personally, it is God.  God knew all of us before we were born.  According to Jeremiah 1:5 states that: Before you were born, I knew you, before you were born, I sanctified you, and ordained you as a prophet to the Nations.

   God understands our heart, mind, soul, and emotions.  I have been writing essays for the past 30 years now.  I have been keeping a journal since I was in the 7^th grade.  I have been writing down my personal feelings inside of a tablet for many years now.  The teachers used to remind all of us as students to write down our personal feelings.  This is what I have been doing for 45 years now.

        I write down all of my feelings.  I share my journal with my therapist.  I have been sharing with him what the voices have been saying to me.  Yes, I suffer from Schizoid Affective Disorder right now.  I have been suffering from a mental illness for the past 25 years now.

  I know that God is with me every single day of the week.  My therapist does not want me to write down what the voices are saying to me.  It is like; living inside of the problem all over again.  I am trying to cope with something that I have had for the past 25 years now.  I am a very happy person right now. I have been keeping my emotions in check for the past 13 years now.

      Finally, I want to inform all of you that I love all of you very much.  I have been clean and sober for the past 32 years now.  I have not smoked marijuana since Wednesday May 2, 1990.  I have not consumed any alcohol since May 2, 1990.  I am very happy to be clean and sober right now. 

In Conclusion, I want to say that I do not hang around my friends, who drink alcohol and smoke marijuana because I can end up getting caught up all over again.  I do not smoke cigarettes.  I have not smoked a cigarette since January 21, 1990.  This is the reason why I know that God is with me.  I am very happy to become a Child of The Most High God.  I am happy, joyous, and free.

Psalm 147:3, And What It Means to All People.

      Good Day Everyone!!  How are you doing today?  Fine, I hope.  I want to inform all of you that Psalms 147:3 is the topic of today.  Psalms 147:3 says; He health the broken in heart, and bindeth up their wounds.  This Bible verse means that God is with all of us.

  He heals our broken hearts, and He bindeth up our wounds.  I want to say that God is my best friend.  God is my Best Friend because He hears my cries, and He smiles at me when I am doing something good.  I know that God rejoices when we do things that pleases Him.

Further, I want to inform all of you that God helped me graduate from college on two occasions.  I want to say that God is responsible for helping me with my bad attitude.  I know this because; His Spirit is inside of me. According to John 14:26, it states that He will give you an Advocate, which is the Holy Spirit to teach you, and put things into your remembrance.

      The Lord is still inside of us.  He is doing for all of us, more than we are doing for ourselves.  I want to inform all of you that everything that is inside of the Holy Bible is the truth.  At least, I can say that it reminds me of the Footprints inside of the Sand. God is really with us at all times. 

I know for me personally, I remember when I used to use vulgarity all of the time.  Right Now, I ask God to remove the bad thoughts that I have inside of my heart.  I know that we have to remember who is in charge right now.  It is not me; personally, it is God.  God knew all of us before we were born.  According to Jeremiah 1:5 states that: Before you were born, I knew you, before you were born, I sanctified you, and ordained you as a prophet to the Nations.

   God understands our heart, mind, soul, and emotions.  I have been writing essays for the past 30 years now.  I have been keeping a journal since I was in the 7^th grade.  I have been writing down my personal feelings inside of a tablet for many years now.  The teachers used to remind all of us as students to write down our personal feelings.  This is what I have been doing for 45 years now.

        I write down all of my feelings.  I share my journal with my therapist.  I have been sharing with him what the voices have been saying to me.  Yes, I suffer from Schizoid Affective Disorder right now.  I have been suffering from a mental illness for the past 27 years now.

  I know that God is with me every single day of the week.  My therapist does not want me to write down what the voices are saying to me.  It is like; living inside of the problem all over again.  I am trying to cope with something that I have had for the past 27 years now.  I am a very happy person right now. I have been keeping my emotions in check for the past 15 years now.

      Finally, I want to inform all of you that I love all of you very much.  I have been clean and sober for the past 33 years now.  I have not smoked marijuana since Wednesday May 2, 1990.  I have not consumed any alcohol since May 2, 1990.  I am very happy to be clean and sober right now. 

In Conclusion, I want to say that I do not hang around my friends, who drink alcohol and smoke marijuana because I can end up getting caught up all over again.  I do not smoke cigarettes.  I have not smoked a cigarette since January 21, 1990.  This is the reason why I know that God is with me.  I am very happy to become a Child of The Most High God.  I am happy, joyous, and free.

I want to start things off by saying that I have full blown Diabetes.  I know that Jesus Christ will help me to cope with the disease.  I have to really watch what I eat and drink on a daily basis.  It really hurts me so much �. I also know that I have Peripheral Artery Disease.  I  suffer from Grandmal Seizures, Gastric Ulcers, and Schizoid Affective Disorder.  I suffer from other physical problems that I am taking medication at the moment.

I know that I have to change everything in my life right now.  I have to allow God to help me out.  I have to go to the hospital on a regular basis.  I have to check my blood sugar levels on a daily basis.  I have to watch my stress levels on a daily basis.  I have to take my Medfordman on a daily basis before eating breakfast. I have to attend church on a regular basis.  I have to keep my emotions in check for the rest of my life.  As long as I am living with a terminal disease, I have to become humble and meek because I am not trying to leave here foolishly.  I also have to change my environment.  My family members use vulgarity towards me because I am only telling them that marijuana and other drugs are inside of my building.  Lord Jesus, I am asking you to please lead me and guide me along in this process.

Next, I have to consult with an endocrinologist and a podiatrist on a regular basis.  I have to maintain a personal relationship with God.  I have to lose weight really bad.  I also have to take my other medications on a daily basis as well.  I have to get a grip of this problem in order for me to maintain my sanity.  This is not a very easy topic to talk about because I tend to blame my own self for this problem.  I know that I have placed this problem inside of God’s Hands right now.  I have been overweight for a very long time right now.  I want to inform all of you that I am going to continue to share my personal feelings about Diabetes.  Perhaps, I can become an ambassador for this disease.

Finally, I have to go to the library on a regular basis in order to get out of my apartment building each day.  I also have to stop using vulgarity and have a positive attitude about life in general.  I have to see my therapist and psychiatrist on a regular basis.  have never been through anything like this before.  This is the first time for everything.  I realize that I have been anemic for 25 years now.  I have noticed when it gets cold outside, I tend to shiver really bad.  Therefore, cool weather and environments are not my best friend.  I tend to get cold while I am at home with the A/C is on.  I do not have enough red blood inside of my body.  I will admit that I have been taking over 25 medications per day for at least 27 years now.  Sometimes taking too much medication can take a complete toll on your body.  I have to question all of my current physicians right now because I really need to know how I ended up with Diabetes at an early age.  I know that I had taken Depakote for a mood stabilizer and seizure medication in the past.  I know that I had gained 85 pounds in one year in the year 1998.  There are times when doctors prescribe too much medication.  Especially when you are a Psychiatric Patient just to stabilize you within a short period of time.

I want to start things off by saying that I have full blown Diabetes.  I know that Jesus Christ will help me to cope with the disease.  I have to really watch what I eat and drink on a daily basis.  It really hurts me so much 😭. I also know that I have Peripheral Artery Disease.

I know that I have to change everything in my life right now.  I have to allow God to help me out.  I have to go to the hospital on a regular basis.  I have to check my blood sugar levels on a daily basis.  I have to watch my stress levels on a daily basis.  I have to take my
Medfordman on a daily basis before eating breakfast. I have to attend church on a regular basis.

Next, I have to consult with an endocrinologist and a podiatrist on a regular basis.  I have to maintain a personal relationship with God.  I have to lose weight really bad.  

Finally, I have to go to the library on a regular basis in order to get out of my apartment building each day.  I also have to stop using vulgarity and have a positive attitude about life in general.  I have to see my therapist and psychiatrist on a regular basis.

Your grammar-IQ is 181.

Your grammar-IQ is 181. Like most geniuses, you have the potential to advance human knowledge!

You are observant and instinctive, and you have philosophical tendencies. You believe in the importance of art, and you question common sense. Romance is the foundation of your happiness. You believe that love overcomes all obstacles and feel supported within the comfort of intimacy. You like to read, you have a lot of theories, and you are more interested in intellectual pursuits than anything else. You examine yourself objectively, and your interests are wildly eclectic. Does this sound like you? Let us know in the comments, and SHARE this Grammar-IQ test to challenge your friends.

Wentworth Hi Rise Apartments

                           Vs

The City of Dayton, Ohio Harrison Township

Good Day Everyone!!  My Name is Anthony Joseph Hopkins, and I am writing a Comparison and Contrast Paper regarding Wentworth Hi Rise Apartments Vs the City of Dayton, Ohio.

First, I would like to make a few observations regarding Wentworth Hi Rise Apartments.

Population:

The Population at Wentworth Hi Rise Apartments consists of 200 People living inside of a building that has six floors.  The building itself used to be a Convalescent Center during the 1970s.  The Population at Wentworth Hi Rise is located at 2765 Wentworth Avenue Dayton, Ohio 45406.  However, the Population at Wentworth Hi Rise Apartments is a mixed community.

Further, there are extra individuals, who are hiding from law enforcement.  There is a minority of people, who are selling fentanyl and marijuana on a regular basis.  There is also an unfamiliar street drug called TANQ that is available in the Wentworth Hi Rise Community.

Next, I want to inform all of you that Wentworth Hi Rise Apartments is a sanctuary for criminals.  There are criminals from all diverse backgrounds, who are avoiding prosecution right now.

 I am only addressing a small population of people, who are selling drugs of all types to its own people.  There is competition on all six floors at Wentworth Hi Rise.  Therefore, these criminals are made up of a hierarchy of criminals inside of the community.

Moreover, I want to inform all of you that; there is a working class of people who live inside of Wentworth Hi Rise.  The street itself is very diverse.  There are other people who are congregating inside of Wentworth Hi Rise on a daily basis.

Drug Scene:

The drug scene is what I am very concerned about right now.  I know that we all make choices in our lives that has an adverse effect on our behavior.  I know this because I used to be an alcoholic and an addict for 18 years.  From 1972-1990, I used to drink beer and wine on a daily basis.  From 1974-1990, I started smoking marijuana on a daily basis.  For 18 years, I have walked the pavement just to go and purchase my drug of choice.  The drug scene inside of this part of Harrison Township smells like marijuana and other drugs inside of the neighborhoods at large.

Otherwise, the Population at Wentworth Hi Rise Apartments have some good people living inside of the neighborhood.  I have been living inside of Wentworth Hi Rise Apartments for going on 13 years.  As far as the inside of the building is concerned, it is really in need of a lot of work.  For Example, the Air Ducts and Vents inside of every apartment need cleaning out.

In Addition, I want to inform all of you that the floors inside of the hallways are somewhat clean.  The floors inside of the second floor are immaculate. 

There are other floors that are inside of the building that are clean.  Whereas, the lower floors are decent.  With the exception of the marijuana smell that you come in contact with as soon as you walk inside of the building.  You can smell the marijuana through the air circulation vents.

Inside of Wentworth Hi Rise Apartments:

I have taken a few pictures of the inside and outside of the building.  This will confirm and verify what the condition of the building as a whole.

Staff:

The Staff at Wentworth Hi Rise are very understanding people.  The staff members and I have an understanding relationship with each other.  I know that; the property manager is doing his best to maintain the property, while he is on duty.  The other staff members are doing their very best to maintain the grounds outside as well as the inside maintenance each day.

Administration:

The Administration consists of people who are high ranking officials and a CEO of the company called The Greater Dayton Premier Management.  The CEO refused to address any of my concerns herself.  Therefore, I am not going to give this company an A+ Rating.  I am giving this company a D- Rating.

Laundry Room:

The Laundry Room has brand new Washers and Dryers inside of it.  The price to wash clothes here had increased due to the Cost of Living Adjustment.  The cost to purchased new appliances have went up dramatically since 2010.

Front of The Building:

The maintenance staff hired a private company to maintain its groundskeeping tasks.  I want to say that; the sidewalks and benches are very clean.  The maintenance staff are doing their best to maintain the upkeep of the Wentworth Hi Rise Apartments.

Atmosphere:

The atmosphere both inside and outside of Wentworth Hi Rise Apartments smell like marijuana.  I can understand why the visitors complain about the marijuana smell from the outside of the building.

Diabetes and what it means to me.  Diabetes is a blood disease that affects the red blood cells of an individual who has it.  It can affect internal organs of the human body. For Example, I have anemia and it affects the red blood cells.  I tend to get cold inside of a warm environment.  As of right now, I have to make a lot of changes in my life.  I have to watch my stress levels and change my environment.  I even have to change what I am eating and drinking each day.

Finally, I have to start over in my life right now.  I know when I received the news about my health, I started crying because I have never went through anything like this.  I guess I am not as healthy as I once thought.  I am having a very hard time losing weight.  I am slowing down in my life right now.  I am taking too much medicine each day.  Please keep me in your prayers and thoughts.  I’m very sorry for my personal rants online.

Front of The Building

The maintenance staff hired a private company to maintain its groundskeeping related tasks.  However, the sidewalks and benches are clean.  The maintenance staff are doing their very best to maintain the building.  The South Fire Escape needs a power washing job.  The City of Dayton, Ohio Metropolitan Population is less than 140,000 people who live here in the best of Aviation City. 

Neighborhood Called Northern Hills

The Northern Hills Community is very diverse.  The Population of Northern Hills is less than 5,000 residents.  In Addition, Northern Hills has Churches, Restaurants, and a group of very friendly neighbors.  At least, it is very hospitable.  I want to inform all of you that this area is inside of Harrison Township.

Harrison Township and The City of Dayton:

The Harrison Township Area is one of the largest townships inside of the City of Dayton.  Harrison Township has a 15-mile radius.  It also runs into the Community of Northridge and Butler Township.

Wentworth Avenue as A Whole:

Wentworth Avenue has at least 50 homes that are located on the street.  There is a vacant lot that sits adjacent to the Dayton Baptist Church.  Most of the residents that live on Wentworth Avenue are Democrats.  Therefore, a Needs Assessment need to be done in order to address the needs of the residents that live at Wentworth Hi Rise Apartments and private homes that are along the street of Wentworth Avenue.  This Neighborhood is very nice, although the smell of marijuana and other drugs are inside of the community.

Pictures of Wentworth Hi Rise Apartments and Outside of the Neighborhood:

These Three Pictures are of the Outside of the Building.  At night, everything jumps off!!  For Example, if a person needs anything in reference to the drug trade: This is Your Flava!!  I know that this area is well populated during the day as well.  For Instance, I would like to sell my items that are inside of my apartment or donate them to Charity!!

Overall, I know that the apartment complex has its ups and downs, but if you are able to tolerate the smell of marijuana and other drugs, then this is a very good fit for you.  I know that there is a competitive spirit inside of the Walls of Wentworth Hi Rise Apartments.

I would like to say that I have been underestimated by many!!  God will always have the first and the last word!!

My Personal Assessment Consists of the Following:  A playground for the children that are currently living inside of Wentworth Hi Rise Apartments with their parents.  An Example of this would be an area where children can play with playground equipment.  AA/NA Meetings for those who are in active addiction while living inside of Wentworth Hi Rise Apartments.  These meetings should occur around the clock!!

A Police Station need to be located inside of Wentworth Hi Rise Apartments in order to address the needs of the citizens of Wentworth Hi Rise Apartments.  Due to the round the clock criminal activities on all six floors.  I have come to realize that Wentworth Hi Rise Apartments is a sanctuary for criminals.  These criminals are blending in with the population at Wentworth Hi Rise Apartments.  The Cameras that are inside of the building should be linked with the United States Department of Homeland Securities.

There is a small population of women who reside inside of Wentworth Hi Rise Apartments with their children.  They are inhaling second hand smoke that comes from marijuana, cigarettes, and other drugs.  There is a Black and Mild Population that smoke and freak their black and mile cigars with marijuana and other drugs.

  The Second-Hand Smoke can cause cancer and other diseases.  This is very dangerous for the small children to inhale the smoke that is coming from these substances.  I recommend that this should become an all Non-Smoking Community that is free from all types of drugs.  Alcohol is a drug!!  I know that earlier in the month, public urination inside of the building is very frequent.  This is a major problem that is inside of the building.  There are a small population of residents who drink beer, wine, and hard liquor on a regular basis.

This is my Assessment and I hope to have these recommendations approved by The County Board of Commissioners and both State and Federal Government Agencies.  I know that the current property manager think that this is all in my mind.  This is serious!!  Thank You for Your Cooperation.

Written and Faithfully Submitted, By: Mr. Anthony Joseph Hopkins

This is an opportunity to Repent of all of my sins.  First, I want to thank God for allowing me to confess all of my faults and transgressions to you.  I am surrendering to only You.  I will admit that I have made some mistakes in judgement.  This is because I was only informing another person about a specific problem.  Lord God, I wanted this illegal activity that is going on in the building to stop.  This drug problem has taken a toll on me physically, mentally, psychologically and spiritually. I am taking the Bible seriously now.

Next, I have been feeling very sick physically because of the smell of marijuanaand other drugs that the residents and criminals are indulging in at the moment.  For Example, I made a phone call to My AA Sponsor because I was vomiting up blood on Sunday of this week.  The Property Manager quarrelled with me about the drug problem that is taking place inside of Wentworth Hi Rise Apartments.  I had to get transported to Grandview Hospital because I smelled something like marijuana laced with fentanyl.

Finally, I want to inform those who are in the Drug Selling Trade that God is watching you and me.  I know that my neighbor’s are still awake because I have decided to do some writing.  Lord Jesus, I love my neighbors however, do they love me in return? 85% percent of the residents love and respect me for me.  I am in need of prayers right now because I am dealing with too many health issues.  Lord Jesus, I am in need of Your Protection right now.  Lord,  whatever I have done wrong. Only you understand as well as the 85% of the residents in the building!