Metformin Adjunctive Therapy with Insulin Improves Glycemic Control in Patients with Type 1 Diabetes Mellitus: A Pilot Study

Gómez, Ricardo; Mokhashi, Moinuddin H; Rao, Jayashree K.; Vargas, Alfonso; Compton, Terry; McCarter, Robert; Chalew, Stuart A.

doi:10.1515/jpem.2002.15.8.1147

Cited by 26 publications

(30 citation statements)

References 5 publications

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“…Sarnblad et al [18] showed a 0.8% decrease in HbA 1c levels after treatment for 3 months. Similar results have been observed in other non-randomized studies performed in adolescents [37,38]. In adults, the effect of metformin on metabolic control has been controversial, and patients with optimal metabolic control have not exhibited benefits with this treatment [39,40,41,42].…”

Section: Discussionsupporting

confidence: 84%

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

et al. 2013

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Background: A high prevalence of hyperandrogenism has been reported in women with type 1 diabetes (T1D). Metformin has been used as a therapeutic agent in patients with polycystic ovarian syndrome and in T1D patients without hyperandrogenism. This study sought to determine the effect of metformin on hyperandrogenism and ovarian function in adolescents with T1D. Methods: We recruited 24 girls with T1D. The participants had hyperandrogenism and displayed suboptimal metabolic control. The patients were enrolled in a randomized, double-blind, placebo-controlled trial. One group received metformin (850 mg bid) and the other group received a placebo. Treatment was administered for 9 months. Ovulation, steroids and gonadotropin levels were evaluated. Results: Metformin treatment was associated with decreases in testosterone, free androgen index, androstenedione, 17-OH progesterone and estradiol levels. The girls who were treated with placebo showed stable steroid, gonadotropin and sex hormone-binding globulin levels during the analysis. No differences were observed in the Ferriman-Gallwey scores, ovulation rates, HbA_1c levels or daily insulin doses of the girls treated with metformin compared with the placebo group. Conclusion: Treating hyperandrogenic T1D adolescents with metformin significantly decreased the serum androgens compared to the placebo, but metformin therapy did not significantly affect clinical parameters, such as hirsutism, ovulation and metabolic control.

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Section: Discussionsupporting

confidence: 84%

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

et al. 2013

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“…In total, 47 of these publications were judged to be relevant to metformin therapy in type 1 diabetes. Analysis of publications revealed: 17 were observational studies with no random allocation and/or no comparator group [18,22,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]; 11 were reviews, letters or commentaries [43][44][45][46][47][48][49][50][51][52][53]; two did not contain any quantitative estimates of effects [54,55]; one concerned an outcome (erythrocyte binding of insulin) not judged relevant [56]; and four were abstracts of papers subsequently published [57][58][59][60]. Of the remaining 12 publications, one concerned insulin-requiring type 2 diabetes rather than type 1 diabetes (noted after translation) [61], and one covered a treatment period of fewer than 7 days [62].…”

Section: Resultsmentioning

confidence: 99%

“…• Observational; no random allocation and/or comparator groups (n=17) [18,22,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] • Review, commentary, letter (n=11) [43][44][45][46][47][48][49][50][51][52][53] • Insufficient numerical data (n=2) [54,55] • No relevant outcome (n=1) [56] • Abstract of later paper (n=4) [57][58][59][60] • No evidence of type 1 diabetes after translation (n=1)…”

Section: Resultsmentioning

confidence: 99%

The use of metformin in type 1 diabetes: a systematic review of efficacy

et al. 2010

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Aims/hypothesis As adding metformin to insulin therapy has been advocated in type 1 diabetes, we conducted a systematic review of published clinical trials and clinical trial databases to assess the effects on HbA 1c , weight, insulin-dose requirement and adverse effects. Methods We constructed evidence tables and fitted a fixedeffects model (inverse variance method) in order to assess heterogeneity between studies and give a crude measure of each overall treatment effect. Results Of 197 studies identified, nine involved randomisation with informed consent of patients with type 1 diabetes to metformin (vs placebo or comparator) in either a parallel or crossover design for at least 1 week. We noted marked heterogeneity in study design, drug dose, age of participants and length of follow-up. Metformin was associated with reductions in: (1) insulin-dose requirement (5.7-10

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“…Recently, Jones et al (11) reported on a randomised double-blind placebo-controlled trial with metformin in adolescents with type 2 diabetes, where they noted an improvement in fasting plasma glucose. There have also been reports from studies in adolescents with type 1 diabetes demonstrating a reduction of glycated haemoglobin (HbA 1c ) during 6 month trials (12), although the effect was transient in one of them (13).…”

Section: Introductionmentioning

confidence: 99%

Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity

Särnblad

Kroon

Åman

2003

European Journal of Endocrinology

109

158

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Objective: Metabolic control often deteriorates during puberty in children with type 1 diabetes. The aim of the present study was to investigate whether addition of metformin for 3 months improves metabolic control and insulin sensitivity. Design: Twenty-six of 30 randomised adolescents with type 1 diabetes (18 females, eight males) completed a double-blind placebo-controlled trial. Their mean age was 16.9^1.6 (S.D.) years, mean glycated haemoglobin (HbA 1c ) 9.5^1.1% and daily insulin dosage 1.2^0.3 U/kg. The participants were randomised to receive oral metformin or placebo for 3 months. HbA 1c was measured monthly, and peripheral insulin sensitivity was assessed by a euglycaemic hyperinsulinaemic clamp at baseline and at the end of the study. Results: HbA 1c decreased significantly in the group treated with metformin, from 9.6 to 8.7% (P , 0.05), but was unchanged in the placebo group (9.5 vs 9.2%). Peripheral glucose uptake divided by mean plasma insulin concentration was increased in the metformin group (P , 0.05) but not in the placebo group. Initial insulin sensitivity was inversely correlated to changes in HbA 1c (r ¼ 20.62; P , 0.05) and positively correlated to changes in insulin sensitivity (r ¼ 0.77; P , 0.01). Conclusions: In this double-blind placebo-controlled study we found that metformin improves metabolic control in adolescents with type 1 diabetes. The effect seems to be associated with an increased insulin-induced glucose uptake.

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Metformin Adjunctive Therapy with Insulin Improves Glycemic Control in Patients with Type 1 Diabetes Mellitus: A Pilot Study

Cited by 26 publications

References 5 publications

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

Metformin for the Treatment of Hyperandrogenism in Adolescents with Type 1 Diabetes Mellitus

The use of metformin in type 1 diabetes: a systematic review of efficacy

Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity

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