Effect of metformin on glycaemic control in patients with type 1 diabetes: A meta‐analysis of randomized controlled trials

Meng, Haiyang; Zhang, Ailing; Liang, Yan; Hao, Jie; Zhang, Xiaojian; Lü, Jingli

doi:10.1002/dmrr.2983

Cited by 46 publications

(44 citation statements)

References 38 publications

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“…Higher rates of gastrointestinal side effects and hypoglycaemia were seen in the metformin group compared with placebo. The risk of diabetic ketoacidosis was not observed to be increased [25].…”

Section: Metforminmentioning

confidence: 88%

“…In a meta-analysis of studies comparing metformin vs placebo, metformin was not associated with improved glycaemic control in adults with Type 1 diabetes, but did improve BMI, and reduced insulin requirement as well as total and LDL cholesterol levels [25]. The risk of diabetic ketoacidosis was not observed to be increased [25]. The risk of diabetic ketoacidosis was not observed to be increased [25].…”

Section: Metforminmentioning

confidence: 95%

“…Metformin's mechanism of action involves delaying intestinal glucose absorption, reduction of hepatic glucose production, increase in glucose uptake in muscle, and, in turn, improvement in insulin sensitivity [16]. In general, compared with placebo, metformin has shown improvement in glycaemic control in adolescents but mixed results in adults, with beneficial effects on weight and BMI, and reduction in insulin requirement (Table 2) [24,25]. In general, compared with placebo, metformin has shown improvement in glycaemic control in adolescents but mixed results in adults, with beneficial effects on weight and BMI, and reduction in insulin requirement (Table 2) [24,25].…”

Section: Metforminmentioning

confidence: 99%

“…Metformin has been studied in adolescents [17,18] and adults [19][20][21][22][23][24] with Type 1 diabetes. In general, compared with placebo, metformin has shown improvement in glycaemic control in adolescents but mixed results in adults, with beneficial effects on weight and BMI, and reduction in insulin requirement (Table 2) [24,25].…”

Section: Metforminmentioning

confidence: 99%

“…Metformin has benefits with regard to metabolic syndrome in reducing body weight, LDL cholesterol and insulin requirement [24]. In a meta-analysis of studies comparing metformin vs placebo, metformin was not associated with improved glycaemic control in adults with Type 1 diabetes, but did improve BMI, and reduced insulin requirement as well as total and LDL cholesterol levels [25]. Higher rates of gastrointestinal side effects and hypoglycaemia were seen in the metformin group compared with placebo.…”

Section: Metforminmentioning

confidence: 99%

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Non‐insulin treatments for Type 1 diabetes: critical appraisal of the available evidence and insight into future directions

Wright

Hirsch

2019

Diabet. Med.

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Intensive insulin therapy is the mainstay of treatment for people with Type 1 diabetes, but hypoglycaemia and weight gain are often limiting factors in achieving glycaemic targets and decreasing the risk of diabetes-related complications. The inclusion of pharmacological agents used traditionally in Type 2 diabetes as adjuncts to insulin therapy in Type 1 diabetes has been explored, with the goal of mitigating such drawbacks. Pramlintide and metformin result in modest HbA 1c and weight reductions, but their use is limited by poor tolerability and, in the case of pramlintide, by frequency of injections and cost. The addition of glucagon-like peptide-1 receptor agonists to insulin results in improved glycaemic control, reduced insulin doses and weight loss, but this is at the expense of higher rates of hypoglycaemia and hyperglycaemia with ketosis. Sodium-glucose co-transporter-2 and dual sodium-glucose co-transporter-2 and -1 inhibitors also improve glucose control, but with reductions in weight and insulin requirements potentiating the risk of acidosis-related events and hypoglycaemia. The high proportion of people with Type 1 diabetes not achieving glycaemic targets, the negative clinical impact of intensive insulin therapy and the rise in obesity and cardiovascular disease and mortality, underline the need for individualized clinical care. The evaluation of new therapies, effective in Type 2 diabetes, as adjuncts to insulin therapy represents a promising strategy, particularly given the beneficial effects on cardiovascular and renal outcomes in people with Type 2 diabetes with or at high risk of complications that are also observed in patients with Type 1 diabetes. As the population with Type 1 diabetes ages, our mission is to evolve and provide better tools and improved therapies to excel, not only in glycaemic control but also in risk reduction and reduction of complications.

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Section: Metforminmentioning

confidence: 88%

Section: Metforminmentioning

confidence: 95%

Section: Metforminmentioning

confidence: 99%

Section: Metforminmentioning

confidence: 99%

Section: Metforminmentioning

confidence: 99%

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Non‐insulin treatments for Type 1 diabetes: critical appraisal of the available evidence and insight into future directions

Wright

Hirsch

2019

Diabet. Med.

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Vascular and metabolic effects of metformin added to insulin therapy in patients with type 1 diabetes: A systematic review andmeta‐analysis

Liu

Chen

et al. 2020

Diabetes Metabolism Res

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Background The incidence of type 1 diabetes mellitus (T1DM) is increasing among youth worldwide, translating to an increased risk ofearly‐onset cardiovascular disease (CVD). Mounting studies have shown that metformin may reduce maximal carotidintima‐media thickness (cIMT), improve insulin resistance and metabolic control in subjects with T1DM, and thus, may extend cardioprotective benefits. This systematic review and meta‐analysis was performed to assess the efficacy and safety of metformin added to insulin therapy on reducing CVD risks and improving metabolism in T1DM. Methods PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) that compared metformin and insulin combination (duration ≥3 months) to insulin treatment alone in T1DM. Data were expressed as weighted/standardized mean differences (MDs/SMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, along with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the overall certainty of the evidence. Results Nineteen RCTs (n = 1540) met the eligibility criteria. Metformin treatment significantly reduced carotid artery intima‐media thickness (MD −0.06 mm [95% CI −0.88, −0.28], P < .001). Though no significant difference was found in insulin sensitivity (SMD 2.21 [95% CI −1.88, 6.29], P = .29), the total daily insulin dosage (SMD −0.81 [95% CI −1.25, −0.36], P < .001) along with traditional CVD risk factors showed improvement by better glycaemic control, partial lipid profiles, diastolic blood pressure, and limited weight gain, with neutral effect on diabetic ketoacidosis, lactic acidosis, and hypoglycaemia. However, metformin therapy increased the incidence of gastrointestinal adverse events. Conclusions Metformin with insulin has the potential to retard the progression of atherosclerosis and provides better metabolic control in patients with T1DM, and thus, providing a potential therapeutic strategy for patients with T1DM on reducing CVD risks.

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Drug Resistance in Diabetes

Khaliq

Chughtai

Iqbal

et al. 2021

Biochemistry of Drug Resistance

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Effect of metformin on glycaemic control in patients with type 1 diabetes: A meta‐analysis of randomized controlled trials

Cited by 46 publications

References 38 publications

Non‐insulin treatments for Type 1 diabetes: critical appraisal of the available evidence and insight into future directions

Non‐insulin treatments for Type 1 diabetes: critical appraisal of the available evidence and insight into future directions

Vascular and metabolic effects of metformin added to insulin therapy in patients with type 1 diabetes: A systematic review andmeta‐analysis

Drug Resistance in Diabetes

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