The use of metformin in type 1 diabetes: a systematic review of efficacy
Open accessAbstract
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 fixed-effects 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 (5.7-10.1 U/day in six of seven studies); (2) HbA(1c) (0.6-0.9% in four of seven studies); (3) weight (1.7-6.0 kg in three of six studies); and (4) total cholesterol (0.3-0.41 mmol/l in three of seven studies). Metformin was well tolerated, albeit with a trend towards increased hypoglycaemia. Formal estimates of combined effects from the five trials which reported appropriate data indicated a significant reduction in insulin dose (6.6 U/day, p < 0.001) but no significant reduction in HbA(1c) (absolute reduction 0.11%, p = 0.42). No reported trials included cardiovascular outcomes.Conclusions/interpretation Metformin reduces insulin-dose requirement in type 1 diabetes but it is unclear whether this is sustained beyond 1 year and whether there are benefits for cardiovascular and other key clinical outcomes.
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Addition of metformin to insulin therapy in type 1 diabetes is associated with reductions in insulin-dose requirement and HbA1c levels.
“The addition of metformin to insulin therapy in type 1 diabetes is also associated with reductions in insulin-dose requirement and HbA1c levels [30,31].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [30]
There is some evidence that suggests improvement in metabolic control of poorly controlled adolescents with type 1 diabetes when metformin is added to insulin therapy.
“There is some evidence that suggests improvement in metabolic control of poorly controlled adolescents with type 1 diabetes when metformin is added to insulin therapy.”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [30]
Metformin has been shown to reduce insulin dose requirement (5.7-10.1 U/day), HbA1c (0.6-0.9%), weight (1.7-6.0 kg), and total cholesterol (0.3-0.41 mmol/l) in adolescents with type 1 diabetes.
“Metformin has been shown to reduce insulin dose requirement (5.7–10.1 U/day), HbA1c (0.6–0.9%), weight (1.7–6.0 kg), and total cholesterol (0.3–0.41 mmol/l) [30].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [30]
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- Authors
- Vella, S., Buetow, L., Royle, P., Livingstone, S., Colhoun, H. M., & Petrie, J. R.
- Affiliations
- University of Dundee (GB)
- University of Aberdeen (GB)
- Corresponding author
- Petrie, J. R.
- Venue
- Diabetologia
- Published
- 2010-01-08
- Volume
- 53
- Issue
- 5
- Pages
- 809-820
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1965620761
- Cited by
- 201
- References
- 77
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 11 · 2022: 12 · 2021: 8 · 2020: 14 · 2019: 10 · 2018: 17 · 2017: 27 · 2016: 21 · 2015: 19 · 2014: 12 · 2013: 13 · 2012: 11
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- Pfizer
- University of Aberdeen
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- metformin, type 1 diabetes, insulin dose reduction, HbA1c, body weight, total cholesterol, hypoglycemia, adverse effects
- MeSH terms
- Clinical Trials as Topic, Diabetes Mellitus, Type 1, Drug Therapy, Combination, Humans, Hypoglycemic Agents, Insulin, Metformin, Treatment Outcome
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