Current status of metformin in addition to insulin therapy in adult patients with type 1 diabetes mellitus: An analysis from the Guangdong Type 1 Diabetes Mellitus Translational Medicine Study

J Diabetes. 2020 Oct;12(10):754-760. doi: 10.1111/1753-0407.13025. Epub 2020 Feb 25.

Abstract

Background: Limited data on the efficacy of the additional metformin therapy in patients with type 1 diabetes mellitus (T1DM) under real-life conditions have been available so far.

Methods: Patients aged ≥18 years with a duration of T1DM for at least 1 year were included in this multicenter observational study. Patients with insulin combined with metformin therapy (MET group) were compared with those with insulin therapy only (INS group).

Results: A total of 76 patients in the MET group were compared with 655 patients in the INS group. At baseline, patients with dyslipidemia were more prevalent in the MET group (17.6% vs 9.0%; P = .006), and they also had a higher body mass index (BMI) (21.7 ± 3.2 kg/m2 vs 20.4 ± 2.6 kg/m2 ; P < .001) than those in the INS group. But glycosylated hemoglobin (HbA1c) and daily insulin dose were not significantly different between the two groups. After 1-year follow-up, HbA1c decreased in both groups, while the daily insulin dose decreased in the MET group, but did not change in the INS group (-0.02 IU/kg [-0.16, 0.09] vs 0 IU/kg [-0.09, 0.09]; P = .029). The additional metformin therapy led to no change of BMI and weight in the MET group, while the body weight increased from 53.7 ± 8.6 kg to 55.0 ± 7.9 kg in the INS group (P < .001).

Conclusions: Metformin is initiated more in T1DM patients with dyslipidemia or higher BMI in current practice in China. The addition of metformin is effective in maintaining weight and reducing the insulin dosage without improving glycemic control in patients with T1DM.

背景: 迄今为止, 关于二甲双胍联合胰岛素治疗在1型糖尿病患者中的使用现状及疗效的数据少见报道。 方法: 本多中心观察性研究纳入来自广东省1型糖尿病转化医学研究项目中年龄≥18岁、病程至少一年的1型糖尿病患者, 将使用二甲双胍联合胰岛素治疗的患者(双胍组)与单用胰岛素治疗的患者(胰岛素组)进行比较。 结果: 双胍组76例患者和胰岛素组655例患者纳入分析。基线时, 双胍组的患者较胰岛素组的患者合并高脂血症的比例高(17.6% vs. 9.0%; P=0.006), 且体重指数(BMI)更高(21.7±3.2kg/m2 vs. 20.4±2.6kg/m2 ; P<0.001), 但糖化血红蛋白和胰岛素日剂量两组间无显著性差异。1年随访后, 两组的糖化血红蛋白均下降, 双胍组的每日胰岛素剂量减少, 但胰岛素组没有变化(−0.02 IU/kg[-0.16, 0.09]vs 0 IU/kg[-0.09, 0.09]; P=0.029)。双胍组的患者BMI和体重无明显变化, 而胰岛素组的患者体重由53.7±8.6kg增加到55.0±7.9kg(P<0.001)。 结论: 目前在中国1型糖尿病患者治疗的临床实践中, 二甲双胍在合并高脂血症或BMI较高的患者中使用更多。在1型糖尿病患者中加用二甲双胍治疗可维持体重和减少胰岛素剂量, 但并未改善血糖控制。.

Keywords: 1型糖尿病; adults; metformin; type 1 diabetes mellitus; 二甲双胍; 成人.