Efficacy of metformin on postprandial plasma triglyceride concentration by administration timing in patients with type 2 diabetes mellitus: A randomized cross‐over pilot study

Abstract

Aims/Introduction Preprandial metformin administration significantly reduces postprandial plasma triglyceride levels in animal studies by reducing intestinal absorption through delayed gastric emptying. However, this effect has not been shown in a clinical study. Therefore, we planned to investigate the efficacy of preprandial metformin administration on postprandial hypertriglyceridemia and the related gastrointestinal effects in patients with type 2 diabetes mellitus. Materials and Methods A total of 11 patients taking single‐dose metformin at 500–1,000 mg, with non‐fasting plasma triglyceride levels of 150–1,000 mg/dL, were recruited at a single university hospital. The difference between preprandial and postprandial metformin administration on postprandial hypertriglyceridemia was examined by a meal test. The gastrointestinal effects of metformin, including stomach heaviness, heartburn and satiety, were also assessed using a visual analog scale. Results The mean bodyweight of patients was 80.6 kg (body mass index 27.9 kg/m2), and the mean non‐fasting plasma triglyceride level was 275.9 ± 57.0 mg/dL. The area under the curve of triglyceride during the meal test was significantly lower in the preprandial protocol than in the postprandial protocol (P < 0.05). Compared with postprandial administration, preprandial administration of metformin increased satiety (P = 0.036) without stomach heaviness or heartburn. Conclusions Preprandial metformin administration significantly reduced plasma triglyceride level during meal testing without marked exacerbation of gastrointestinal adverse effects. The present results suggest that a simple change in the timing of metformin administration represents a novel approach for enhancing triglyceride‐lowering strategies in patients with type 2 diabetes mellitus and postprandial hypertriglyceridemia.

A new perspective on the biguanide, metformin therapy in type 2 diabetes and lactic acidosis

“…Metformin is usually taken before each meal. This common sense was clearly confirmed in a recent study on the efficacy of preprandial metformin administration on postprandial plasma triglyceride concentration in patients with type 2 diabetes. The authors observed that preprandial metformin administration significantly reduced plasma triglyceride levels during meal testing, as compared with no significant reduction in the group with postprandial metformin administration.…”

Knowledge, Attitude, and Practice of Metformin Extended-Release Tablets Among Clinicians in China: A Cross-Sectional Survey

“…Less than 2/3 of the clinicians correctly respond to the timing of the drug, according to the drug label ( ® Extended-Releas, 2017 ; ® Tablets and G, 2017 ), which is essential for the drug to reach its optimal glycemic-control effect ( Sato et al, 2019 ). The findings also indicate the potential inappropriate practice of metformin IR use, which call for future investigation.…”

Role of the Gut in Diabetic Dyslipidemia

“…Metformin increased fasting GLP-1 in patients with T2D (88,89) potentially by modulating bile acid pools (88). Interestingly, timing of metformin delivery may alter TG responses as pre-meal metformin decreased postprandial TG to a greater extent than post-meal delivery in patients with T2D and increased satiety with no difference in GLP-1 (90).…”