The Benefits of Metformin Therapy During Continuous Subcutaneous Insulin Infusion Treatment of Type 1 Diabetic Patients
- Laurent Meyer, MD1,
- Philip Bohme, MD1,
- Irene Delbachian, MD1,
- Philippe Lehert, PHD23,
- Nathalie Cugnardey, MD4,
- Pierre Drouin, MD1 and
- Bruno Guerci, MD, PHD1
- 1Service de Diabétologie, Maladies Métaboliques & Maladies de la Nutrition, CIC-INSERM, Hôpital Jeanne d’Arc, Centre Hospitalo-Universitaire de Nancy, Toul, France
- 2Faculty of Medicine, University of Melbourne, Melbourne, Australia
- 3Faculty of Economics, University of Mons, Mons, Belgium
- 4LIPHA Santé, Nogent-sur-Marne, France
OBJECTIVE—This study was designed to assess the insulin-sparing effect of oral administration of metformin along with a continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 62 patients (25 women and 37 men) were studied in a monocenter, randomized, double-blind placebo-controlled study, comparing metformin (850 mg b.i.d.) with placebo in association with CSII during a 6-month period.
RESULTS—Treatment with metformin was associated with a reduction in daily insulin requirements between V0 and V6 of −4.3 ± 9.9 units (−7.8 ± 18%) compared with an increase with placebo treatment of 1.7 ± 8.3 units (2.8 ± 12.7%) (P = 0.0043). A decrease in basal requirement of insulin was also observed in patients treated with metformin of −2.6 ± 3.2 units (−7.9 ± 23.8%) compared with an increase with placebo treatment of 1.9 ± 5.7 units (8.8 ± 27.1%) (P = 0.023). HbA1c remained unchanged in treatment with metformin and placebo between V0 and V6. The number of hypoglycemic events (<60 mg/dl) was similar in both groups. Significant reductions of total cholesterol (P = 0.04) and LDL cholesterol (P = 0.05) were observed in patients treated with metformin. Gastrointestinal events, including diarrhea and abdominal pain, were reported in three patients in the metformin group who discontinued the trial. Mild or moderate gastrointestinal side effects were also reported in eight patients treated with metformin and two patients treated with placebo (P = 0.069).
CONCLUSIONS—Metformin was found to be a safe insulin-sparing agent, when used in combination with CSII for the treatment of type 1 diabetes.
- CSII, continuous subcutaneous insulin infusion
- DCCT, Diabetes Control and Complications Trial
- IR, insulin requirement
- SMBG, self-monitoring of blood glucose
Address correspondence and reprint requests to Dr. Bruno Guerci, Service de Diabétologie, Maladies Métaboliques & Maladies de la Nutrition, CIC-INSERM/CHU Nancy, Hôpital Jeanne d’Arc, Centre Hospitalo-Universitaire de Nancy, B.P. 303, 54201 Toul Cedex, France. E-mail address:.
Received for publication 22 May 2002 and accepted in revised form 23 August 2002.
N.C. is employed by Merck Santé (formerly Lipha Santé, 37 rue Saint Romain, 69379 Lyon Cedex 08, France).
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE