Metformin Improves Glycemic Variability in Adults with Type 1 Diabetes
Mellitus: an open-label randomized control trial
Abstract
Introduction: Metformin has been demonstrated to enhance
cardioprotective benefits in type 1 diabetes(T1DM). Although glycemic
variability (GV) is associated with increased risk of CVD in diabetes,
there is a scarcity of research evaluating the effect of metformin on GV
in T1DM. Objectives: In the present study, the effects of adjuvant
metformin therapy on GV and metabolic control in T1DM were explored.
Patients and methods: A total of 65 adults with T1DM were enrolled and
subjected to physical examination, fasting laboratory tests and
continuous glucose monitoring, and subsequently randomized 1:1 to 3
months of 1000- 2000 mg metformin daily add-on insulin (MET+INS, n=34)
or insulin (INS, n=31). After, baseline measurements were repeated.
Results: The mean amplitude of glycemic excursions was substantially
reduced in the MET+INS group, compared with the INS group (-1.47±3.39
mmol/L versus 1.05±4.24 mmol/L, P=0.012). In parallel, the largest
amplitude of glycemic excursions (-2.28±4.71 mmol/L versus 1.77±5.71
mmol/L, P=0.003), the standard deviation of blood glucose (- 0.62±1.15
mmol/L versus 0.08±1.23 mmol/L, P=0.023), and the coefficient of
variation (-6.08±12.31 % versus 2.29±11.57 %, P=0.008) all
demonstrated improvement in the MET+INS group, compared with the INS
group. Significant reduction in the insulin dose, body mass index and
body weight were observed in patients with MET+INS, not those with INS.
Conclusion: Additional metformin therapy improved GV in adults with
T1DM, as well as improving body composition and reducing insulin
requirement. Hence, metformin as adjunctive therapy has potential
prospects in reducing the CVD risk in patients with T1DM in the long
term.