The effects of metformin in type 1 diabetes mellitus

BMC Endocrine Disorders - Tập 18 - Trang 1-6 - 2018
Selvihan Beysel1,2, Ilknur Ozturk Unsal3, Muhammed Kizilgul4, Mustafa Caliskan5, Bekir Ucan3, Erman Cakal3
1Department of Endocrinology and Metabolism, Eskisehir State Hospital, Eskisehir, Turkey
2Department of Medical Biology, Baskent University, Ankara, Turkey
3Department of Endocrinology and Metabolism, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
4Department of Endocrinology and Metabolism, Kilis State Hospital, Kilis, Turkey
5Department of Endocrinology and Metabolism, Duzce Ataturk State Hospital, Duzce, Turkey

Tóm tắt

This retrospective study investigated the effect of adding metformin to pharmacologic insulin dosing in type 1 diabetics on insulin therapy 1 year after treatment compared with patients on insulin therapy alone. Twenty-nine adults with type 1 diabetes who had metformin added to their insulin therapy for 12 months were compared with 29 adults with type 1 diabetes who remained on insulin-alone therapy. Fifty-eight patients with C peptide negative-type 1 diabetics (26 females, mean age: 29.01 ± 7.03 years, BMI: 24.18 ± 3.16 kg/m2) were analyzed. Age, sex, body weight, insulin dose requirement, plasma glucose (PG), blood pressure (BP), and lipids did not differ between groups before treatment (p > 0.05). Metabolic syndrome (44.8 vs 41.4%, p > 0.05) did not differ between the metformin-insulin and insulin alone groups before treatment. Metabolic syndrome was more decreased in the metformin-insulin group than in the insulin alone group after treatment (−8.9 ± 1.3 vs. 2.5 ± 0.6%, p = 0.028). Insulin dose requirement was lower in the metformin-insulin group than in the insulin alone group (−0.03 vs. 0.11 IU/kg/d, p = 0.006). Fasting PG (−26.9 ± 54.2 vs. 0.7 ± 29.5 mg/dL, p = 0.022) and postprandial PG (−43.1 ± 61.8 mg/dL vs. −3.1 ± 40.1 mg/dL, p = 0.010) was more decreased in the metformin-insulin group than in the insulin alone group. Body weight, lipids, and HbA1c did not differ between the groups (p > 0.05). Metformin decreased glucose concentrations, reduced metabolic syndrome, as well as insulin dose requirement more than insulin therapy alone, 1 year after treatment. These results were independent of blood lipid improvement or weight loss, although on average weight remained decreased with metformin-insulin therapy, whereas the average weight increased with insulin therapy alone.

Tài liệu tham khảo

Chiang JL, Kirkman MS, Laffel LMB, Peters AL, Type 1 Diabetes Sourcebook Authors. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37:2034–54.

Purnell JQ, Hokanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes control and complications trial. JAMA. 1998;280:140–6.

Orchard TJ, Olson JC, Erbey JR, Williams K, Forrest KY-Z, Smithline Kinder L, Ellis D, Becker DJ. Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care. 2003;26:1374–9.

Lund SS, Tarnow L, Astrup AS, Hovind P, Jacobsen PK, Alibegovic AC, Parving I, Pietraszek L, Frandsen M, Rossing P, et al. Effect of adjunct metformin treatment in patients with type-1 diabetes and persistent inadequate glycaemic control. A randomized study. PLoS One. 2008;3:e3363.

Pop A, Clenciu D, Anghel M, Radu S, Socea B, Mota E, Mota M, Panduru NM, RomDianeStudy Group. Insulin resistance is associated with all chronic complications in type 1 diabetes. J Diabetes. 2016;8(2):220–8.

Krochik AG, Botto M, Bravo M, Hepner M, Frontroth JP, Miranda M, Mazza C. Association between insulin resistance and risk of complications in children and adolescents with type 1 diabetes. Diabetes Metab Syndr. 2015;9:14–8.

Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Wadén J, Rönnback M, Rosengård-Bärlund M, Björkesten C-GA, et al. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care. 2005;28:2019–24.

Metascreen Writing Committee, Bonadonna RC, Cucinotta D, Fedele D, Riccardi G, Tiengo A. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey. Diabetes Care. 2006;29:2701–7.

Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the diabetes control and complications trial. Diabetes Care. 2007;30:707–12.

Lauria A, Barker A, Schloot N, Hosszufalusi N, Ludvigsson J, Mathieu C, Mauricio D, Nordwall M, Van der Schueren B, Mandrup-Poulsen T, et al. BMI is an important driver of β-cell loss in type 1 diabetes upon diagnosis in 10 to 18-year-old children. Eur J Endocrinol Eur Fed Endocr Soc. 2015;172:107–13.

Yardley JE, Kenny GP, Perkins BA, Riddell MC, Goldfield GS, Donovan L, Hadjiyannakis S, Wells GA, Phillips P, Sigal RJ, et al. Resistance Exercise in Already-Active Diabetic Individuals (READI): study rationale, design and methods for a randomized controlled trial of resistance and aerobic exercise in type 1 diabetes. Contemp Clin Trials. 2015;41:129–38.

Sorensen JS, Birkebaek NH, Bjerre M, Pociot F, Kristensen K, Hoejberg AS, Frystyk J, Danish Society for Diabetes in Childhood and Adolescence. Residual β-cell function and the insulin-like growth factor system in Danish children and adolescents with type 1 diabetes. J Clin Endocrinol Metab. 2015;100:1053–61.

Dejgaard TF, Knop FK, Tarnow L, Frandsen CS, Hansen TS, Almdal T, Holst JJ, Madsbad S, Andersen HU. Efficacy and safety of the glucagon-like peptide-1 receptor agonist liraglutide added to insulin therapy in poorly regulated patients with type 1 diabetes-a protocol for a randomised, double-blind, placebo-controlled study: the Lira-1 study. BMJ Open. 2015;5:e007791.

Inzucchi SE, Maggs DG, Spollett GR, Page SL, Rife FS, Walton V, Shulman GI. Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. N Engl J Med. 1998;338:867–72.

George P, McCrimmon RJ. Potential role of non-insulin adjunct therapy in Type 1 diabetes. Diabet Med J Br Diabet Assoc. 2013;30:179–88.

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65.

Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D. Metformin as an adjunct therapy in adolescents with type 1 diabetes and insulin resistance: a randomized controlled trial. Diabetes Care. 2003;26:138–43.

Särnblad S, Kroon M, Aman J. Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity. Eur J Endocrinol Eur Fed Endocr Soc. 2003;149:323–9.

Khan ASA, McLoughney CR, Ahmed AB. The effect of metformin on blood glucose control in overweight patients with type 1 diabetes. Diabet Med J Br Diabet Assoc. 2006;23:1079–84.

Meyer L, Bohme P, Delbachian I, Lehert P, Cugnardey N, Drouin P, Guerci B. The benefits of metformin therapy during continuous subcutaneous insulin infusion treatment of type 1 diabetic patients. Diabetes Care. 2002;25:2153–8.

Jacobsen IB, Henriksen JE, Beck-Nielsen H. The effect of metformin in overweight patients with type 1 diabetes and poor metabolic control. Basic Clin Pharmacol Toxicol. 2009;105:145–9.

Konrad K, Datz N, Engelsberger I, Grulich-Henn J, Hoertenhuber T, Knauth B, Meissner T, Wiegand S, Woelfle J, Holl RW, et al. Current use of metformin in addition to insulin in pediatric patients with type 1 diabetes mellitus: an analysis based on a large diabetes registry in Germany and Austria. Pediatr Diabetes. 2015;16:529–37.

DeGeeter M, Williamson B. Alternative agents in type 1 diabetes in addition to insulin therapy: Metformin, alpha-Glucosidase inhibitors, Pioglitazone, GLP-1 agonists, DPP-IV inhibitors, and SGLT-2 inhibitors. J. Pharm Pract. 2016;29(2):144–59.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106:3143–421.

Urakami T, Morimoto S, Owada M, Harada K. Usefulness of the addition of metformin to insulin in pediatric patients with type 1 diabetes mellitus. Pediatr Int Off J Jpn Pediatr Soc. 2005;47:430–3.

Moon RJ, Bascombe, L-A, Holt RIG. The addition of metformin in type 1 diabetes improves insulin sensitivity, diabetic control, body composition and patient well-being. Diabetes Obes Metab. 2007;9:143–5.

Burchardt P, Zawada A, Tabaczewski P, Naskręt D, Kaczmarek J, Marcinkaniec J, Wierusz-Wysocka B, Wysocki H. Metformin added to intensive insulin therapy reduces plasma levels of glycated but not oxidized low‑density lipoprotein in young patients with type 1 diabetes and obesity in comparison with insulin alone: a pilot study. Pol Arch Med. Wewnętrznej. 2013;123:526–32.

Lund SS, Tarnow L, Astrup AS, Hovind P, Jacobsen PK, Alibegovic AC, Parving I, Pietraszek L, Frandsen M, Rossing P, et al. Effect of adjunct metformin treatment on levels of plasma lipids in patients with type 1 diabetes. Diabetes Obes Metab. 2009;11:966–77.

Schwab KO, Doerfer J, Hecker W, Grulich-Henn J, Wiemann D, Kordonouri O, Beyer P, Holl RW, DPV Initiative of the German Working Group for Pediatric Diabetology. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care. 2006;29:218–25.

Thông tin
Thông tin xuất bản

BMC Endocrine Disorders

Tập 18

1-6

Thông tin tác giả