Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin

Abstract

Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/ dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m 2 ), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.

Acute Effect of Metformin on Postprandial Hypertriglyceridemia through Delayed Gastric Emptying

“…This is consistent with previous clinical studies that have shown that metformin reduced plasma TG concentrations in the fasting and postprandial states [8,9,15,16,17,18]. In these studies, metformin treatment for several months increased insulin sensitivity because of improved long-term glycemic control and reduced body weight.…”

A Comparison Between the Therapeutic Effect of Metformin Alone versus a Combination Therapy with Insulin in Uncontrolled, Non-Adherence Patients with Type 2 Diabetes: Six Months Follow-Up

“…No changes were detected in HDL cholesterol or blood pressure. 35 In our study, we also detected a significant reduction in body mass index after six months of treatment among patients treated with the intensive dose of only metformin and also in combination with insulin.…”

Targeting Dyslipidemia in the Metabolic Syndrome: An Update

“…Among others, examples include ezetimibe/simvastatin co-administered with fenofibrate [161], ezetimibe plus fenofibrate [162] or plus a statin [72][73][74][75][76][77][78][79], fenofibrate plus metformin [163] or plus a statin [164,165], statins plus omega-3 fatty acids [166] or plus pioglitazone [167], niacin plus colestipol [88][89][90][91], niacin plus a statin [94][95][96], a combination of niacin, aspirin plus statin [93], or a combination of colesevelam with a statin [124][125][126], ezetimibe [127,168,169] or a fibrate [128]. Furthermore, drugs such as metformin, acarbose and meglitinides may be used in the future in patients with the MetS not only to delay the onset of type 2 diabetes mellitus but also to reduce the increased CVD risk [170][171][172]. There is emerging evidence suggesting that a strong association exists between the MetS and non-alcoholic fatty liver disease (NAFLD) [173][174][175]; a multifactorial intervention of NAFLD in patients with the MetS improves both the ultrasonographic appearance of the liver, as well as the lipid profile in these patients [173][174][175].…”