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Cited by 146Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

The Effects of Metformin on Glycemic Control and Serum Lipids in Insulin-Treated NIDDM Patients With Suboptimal Metabolic Control

Robinson, Adam C, Burke, John, Robinson, Stephen, Johnston, Desmond G, Elkeles, Robert S·1998·Diabetes Care
DOI 10.2337/diacare.21.5.701
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Abstract

OBJECTIVE: To test the hypothesis that metformin therapy, given as an adjunct to insulin therapy, improves metabolic control in insulin-treated NIDDM patients with suboptimal glycemic control. RESEARCH DESIGN AND METHODS: A total of 33 subjects with insulin-treated NIDDM were investigated; all had commenced insulin after secondary failure of antihyperglycemic agents. Two randomized double-blind placebo-controlled crossover studies were run. In study 1 (n = 19), insulin-treated subjects with suboptimal glycemic control received 12 weeks of metformin 1 g b.i.d. and 12 weeks of placebo. In study 2 (n = 14), subjects already established on adjunctive metformin/insulin therapy stopped the metformin component and received 12 weeks of metformin at their baseline dosage (range 1–2.5 g) and 12 weeks of equivalent placebo. Fasting plasma glucose, HbA1c, and serum lipids were measured at baseline and midway through and at the end of each treatment phase. The effect of 12 weeks of metformin treatment was compared with the effect of 12 weeks of placebo in each study and in both studies combined. RESULTS: In study 1, metformin treatment was associated with significant improvements in fasting plasma glucose (mean 12-week difference fromplacebo [95% CI]: 5.8 mmol/1 [3.5–8.1], P < 0.001) and HbA1c (1.6% [0.9–2.4], P < 0.001). In study 2, metformin treatment was associated with significantly lower fasting plasma glucose (5.3 mmol/1 [0.6–9.9], P = 0.029) and lower HbA1c(2.4% [1.0–3.8], P = 0.003) compared with those for placebo. Study 2 also showed metformin treatment to be associated with significantly lower total cholesterol than that for placebo (1.0 mmol/1 [0.1–1.9], P = 0.032) and lower LDL cholesterol (1.0 mmol/1 [0.1–1.9], P = 0.028). This significant difference in serum lipids seen in study 2 was not seen in study 1, but was present when both sets of data were combined (n = 33, mean total cholesterol difference at 12 weeks [95% CI]: 0.6 mmol/1 [0.1–1.1], P = 0.015). Metformin had no significant effect on triglyceride, HDL cholesterol, weight, or blood pressure. Twosubjects on metformin withdrew because of side effects. CONCLUSIONS: Metformin, when given as adjunctive therapy, was well tolerated and improved glycemic control and lipid concentrations in patients with insulin-treated NIDDM whose diabetes was poorly controlled. These improvements could be maintained over the long term.

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Authors
Robinson, A. C., Burke, J., Robinson, S., Johnston, D. G., & Elkeles, R. S.
Affiliations
  • Imperial College London (GB)
  • Barnet Hospital (GB)
ORCID
Johnston, Desmond G
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
1998-05-01
Volume
21
Issue
5
Pages
701-705
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.21.5.701
OpenAlex
W1970337257
Cited by
146
References
24
Citations by year
2023: 6 · 2021: 5 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 4 · 2015: 5 · 2014: 2 · 2013: 2 · 2012: 4
FWCI
5.19
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
metformin, type 2 diabetes, insulin-treated diabetes, glycemic control, HbA1c, fasting blood glucose, serum lipids, LDL cholesterol, total cholesterol, adjunctive therapy, insulin resistance, HMG-CoA reductase inhibition, statins
MeSH terms
Aged, Blood Glucose, Blood Pressure, Body Weight, Cholesterol, Data Interpretation, Statistical, Diabetes Mellitus, Type 2, Diastole, Double-Blind Method, Fasting, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Lipids, Cholesterol, HDL, Cholesterol, LDL, Male, Metformin, Middle Aged, Systole, Triglycerides, Treatment Outcome, Cross-Over Studies

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