Effects of Metformin on Renal Function, Cardiac Function, and Inflammatory Response in Diabetic Nephropathy and Its Protective Mechanism

Abstract

Objective. To investigate the effect of metformin on renal function, cardiac function, and inflammatory response in diabetic nephropathy and its protective mechanism. Methods. A total of 88 patients with diabetic nephropathy who were admitted to our hospital from April 2019 to October 2020 were recruited and grouped according to different treatment methods, namely, the experimental group ( n = 44 ) and the control group ( n = 44 ). The patients in the experimental group were treated with metformin, and the patients in the control group were treated with liraglutide injection (nonmetformin). Left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and inflammatory response (hs-CRP, TNF-α, IL-6) were compared. Results. Compared with corresponding values before treatment, BUN, Scr, hs-CRP, TNF-α, IL-6, LVEDD, and LVESD were decreased after treatment, whereas LVEF was increased (all P < 0.05 ), with significant change in the experimental group (all P < 0.001 ). Conclusion. Metformin can effectively improve the level of renal function and cardiac function in patients with diabetic nephropathy and help patients control and reduce the body’s inflammatory response, and its therapeutic efficacy is superior to that of liraglutide injection.

“Multiomics” Analyses Combined with Systems Pharmacology Reveal the Renoprotection of Mangiferin Monosodium Salt in Rats with Diabetic Nephropathy: Focus on Improvements in Renal Ferroptosis, Renal Inflammation, and Podocyte Insulin Resistance

“…Interestingly, MGM was as effective as Met in improving glycolipid dysmetabolism in the present study, implying that MGM may serve as an alternative therapeutic option for glucose control in patients with responsive or serious adverse effects to Met treatment. In addition, Met elicits its renoprotective effects in DN by inhibiting inflammation and reducing oxidative stress. , In this research, these renoprotective effects of MGM (especially in the context of DN-associated kidney inflammation) were mediated (at least in part) by the MAPK/NF-κB signaling pathway. Even though the levels of proinflammatory cytokines of DN rats were reduced after treatment with Met, expression of activated NF-κB was not inhibited, which suggested that Met facilitates its anti-inflammatory effects in a different way to that of MGM. , Although Met reduced ACSL4 expression in the kidneys of DN rats, it did not reverse the abnormality of mitochondrial ultrastructure in the kidneys.…”

“…In addition, Met elicits its renoprotective effects in DN by inhibiting inflammation and reducing oxidative stress. 93,94 In this research, these renoprotective effects of MGM (especially in the context of DN-associated kidney inflammation) were mediated (at least in part) by the MAPK/NF-κB signaling pathway. Even though the levels of proinflammatory cytokines of DN rats were reduced after treatment with Met, expression of activated NF-κB was not inhibited, which suggested that Met facilitates its anti-inflammatory effects in a different way to that of MGM.…”

Kidney outcomes with SGLT2is for type 2 diabetes patients: does background treatment with metformin or RASis matter?

“…Previous research on the effect of metformin on the renal hemodynamic effects of SGLT2is has yielded conflicting results. The impact of metformin treatment itself on renal function in individuals with type 2 diabetes has been inconsistent; some studies showed kidney benefits ( 20 , 21 ) while others indicated the worsening of renal function ( 22 , 23 ). Moreover, several studies suggested that metformin may facilitate nitric oxide production by stimulating of AMP-activated protein kinase, thereby attenuating the tubuloglomerular feedback action induced by SGLT2is and reducing eGFR responses to SGLT2i therapy ( 24 ).…”

The Safety Profile of Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide 1 Receptor Agonists in the Standard of Care Treatment of Type 2 Diabetes Mellitus

“…Zhang et al [ 54 ], in a study on 88 patients with T2DM that had diabetic nephropathy and were randomized in a 1:1 manner to either metformin (experimental group) or liraglutide (control group), reported similar values of urea and creatinine at baseline. They assessed that both the parameters had lower values, with a more significant effect in the experimental than the control group (urea (51.83 mg/dL ± 12.43) and creatinine (0.82 ± 0.19) versus urea (73.63 mg/dL ± 17.59) and creatinine (1.01 mg/dL ± 0.26)) ( p < 0.0001), similar to the ones from our study, where the patients with T2DM that were treated with the metformin had an improved urea level at V12M, as compared to V0M, and at V12M as compared to V6M.…”