Effect Of Metformin As An Add On Therapy To Type 1 Diabetes Mellitus Biology Research Paper Page 2
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2Original Research Paper
VOLUME-6 | ISSUE-2 | FEBRUARY-2017 • ISSN No 2277 - 8179 | IF : 3.508 | IC Value : 78.46
improvement in HbA1c of 0.5% in the metformin group when
Age distribution of the patients in the two study groups
compared to the insulin only group. Table 2 shows the change from
Age groups of patients
Insulin only
Insulin + Metformin
baseline after 3 months trial.
< 20 yr
15 (28.8%)
12 (23.01%)
20 – 29 yr
7 (13.46%)
9 (17.3)
Metformin treated subjects required significantly lower insulin
dosage on a unit/ kg basis compared to the other group. ere was
30.34 yr
5 (9.6%)
3 (5.7%)
48.18% (43 units to 24 units) decrease in insulin dosage in the
40-49
1 (1.9%)
0
metformin group and 6.18% increase in insulin dosage in the insulin
Change from baseline after months of treatment
only group. e initial fasting blood sugar in the insulin only group
was 220 + 2mg% and in the metformin group was 240 + 3mg% final
Insulin only
Insulin + Metformin
fasting blood sugar in the insulin only group was 154 + 2.8mg% and
Number
28
24
that in the insulin + metformin group was 160 + 2.5mg%. e
Age
20.3 + 1.4
19.4 + 1.8
decrease in fasting blood sugar in both groups were significant there
Sex Male
16
9
was significant reduction of 48.18% insulin dosage in the metformin
Female
12
15
group.
BMI
22 + 1.4
19 +1.8
DISCUSSION
HbA1c
8.028 + 2.28
9.25 + 1.93
In the diabetic control and complications trial clearly demonstrated
I n s u l i n d o s a g e (u n i t s
1.21
0.62
that intensive insulin therapy to achieve heal normal glycemia
/kg/day)
reduces the risk of development and progression of long term
Change from baseline after 3months
complication of type 1 diabetes mellitus but lead to an increase in
hypoglycaemic episodes. Metformin is a biguanide that has been
Characteristics Insulin only Insulin +
Significance
used in the management type 2 diabetes for > 40 years. It improves
Metformin
glycemic control by enhancing insulin sensitivity. In type 1 diabetes
mellitus patients the addition of metformin to insulin therapy has
Hb A1c (%)
1.38s1 + 0.07 1.8 + 0.68
P<0.05
been assessed in a few trials involving few paients with uncontrolled
I n s u l i n d o s e
0.82 + 0.2
- 0.6 + 1
P <0.001
type 1 diates mellitus. ese studies suggested a mean reduction in
(U/kg/day)
insulin resistance. e present study was an attempt to evaluate the
Group statistics
effect of metformin on blood glucose control and insulin dosage in
uncontrolled type 1 diabetes. e study indicates that addition of
Groups
No. of
Mean
SD
metformin to insulin in uncontrolled type 1 diabetes mellitus in
patients
improves insulin sensitivity. e change in glycosylated haemoglobin
HbA1c
Insulin only
28
9.41
1.52
and insulin dosage produced by metformin could be partly due to
change in growth hormone secretion. But this can only explain the
Insulin +
24
10.64
1.70
effect of metformin in adolescents with type 1 diabetes mellitus. e
Metformin
effect of metformin even in elder type 1 diabetics could be due to
HbA1c (after 3
Insulin only
28
8.028
2.28
other effects of metformin like decreased hepatic glucose output and
months)
increase in insulin binding to receptors.
Insulin +
24
9.25
1.93
Metformin
CONCLUSION
Initial insulin
Insulin only
28
43.39
10.87
Majority of patients of type 1 diabetes are of poor socioeconomic
status. Most of them cannot afford lifelong insulin treatment. Many of
Insulin +
24
48
9.8
them stop insulin therapy due to the cost of treatment. e present
Metformin
study demonstrated that targeting insulin resistance with
Final insulin
Insulin only
28
46.39
10.95
metformin, traditionally used to treat type 2 diabetic patients.
Insulin +
24
24.87
6.64
Significantly improves metabolic control in uncontrolled type 1
Metformin
diabetic patients and represents a novel adjunctive therapy in
Hb A1c (%)
Insulin only
28
1.38
0.74
uncontrolled type 1 diabetic patients worthy of further investigation.
is fact is very interesting and helpful in the setting of poor socio
Insulin +
24
1.80
0.68
economic status of the Indian patients.
Metformin
Insulin
Insulin only
28
19.55
12.9
REFERENCES
Insulin +
24
111.92
44.09
1.
e Diabetes Control and Complications Trial Research Group. e effect of intensive
Metformin
treatment of diabetes on the development and progression of long term complications
in IDDM.N Engl. J.Med 1993; 329: 986-997.
Body weight
Insulin only
28
37.7
10.20
2.
Jill Hamilton MD, Elizabeth Cummings MD, Vera Zdravkovic MD, Diane Fingegood,
Denis Daneman MB BCH. Metformin as an adjunct therapy in adolescents with type 1
Insulin +
24
14.8
6.97
diabetes mellitus and insulin resistance : A randomized controlled tiral. Diabetes
Metformin
Care, Jan 2003; 26: 138-143.
3.
Gin H, Messerchmitt C, Brottier E, Aubertin J. Metformin improved insulin resistance
e study group included 52 patients. e inclusion criteria was
in type 2 insulin – dependent diabetic patients. Metabolism. Clinical &Experimental,
1985 Oct; 34 (10) : 923-925.
setout to minimize the likelihood of recruiting subjects with type 2
4.
SArnbald S, Kroon M. Aman J. Metformin as an additional therapy in adolescents with
diabetes mellitus and also those patients who are contraindicated
poorly controlled type 1 diabetes. Randomized placebo controlled trial with aspects
for metformin therapy like renal failure and hepatic dysfunction.
on insulin sensitivity. European Journal of Endocrinology, 2003 Oct; 149(4): 323-329.
5.
Slama G. e insulin sparing effect of metformin in insulin treated diabetic patients.
Insulin sensitivity was not done in the present study due to technical
Diabetic et metabolism. May 1991; 17(2): 241-3.
reasons. But an indirect evidence of insulin resistance was obtained
through the measurement of glycosylated haemoglobin, insulin
dosage and fasting glucose. Compared to insulin only group, age body
mass index and HbA1c were comparable between the 2 groups. T
table 1 shows the baseline demographic data of all subjects. ere
was a decrease in glycosylaed haemoglobin of 1.8 +0068% in the
metformin group. In the insulin only group a decrease of 1.382 +
0.741% was seen. us the trial demonstrated significant (p<0.05)
IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
108
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