Lin Szu Han, Cheng Po Chung, Tu Shih Te, Hsu Shang Ren, Cheng Yun Chung, Liu Yu Hsiu
Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
PeerJ. 2018 Apr 12;6:e4578. doi: 10.7717/peerj.4578. eCollection 2018.
Cardiovascular disease is a major cause of mortality and morbidity in people with type 2 diabetes mellitus (T2DM). Studies have consistently identified dyslipidemia as an important risk factor for the development of macrovascular disease. The landmark United Kingdom Prospective Diabetes Study has shown that metformin therapy reduces cardiovascular events in overweight people with T2DM. This study investigates the effect of metformin monotherapy on serum lipid profile in statin-naïve individuals with newly diagnosed T2DM, and whether the effect, if any, is dosage-related.
This cohort study enrolled individuals exceeding 20 years of age, with recent onset T2DM, who received at least 12 months of metformin monotherapy and blood tests for serum lipid at 6-month intervals. Exclusion criteria involved people receiving any additional antidiabetic medication or lipid-lowering drug therapy. Lipid-modifying effect of metformin was recorded as levels of serum triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) measured at six month intervals.
The study enrolled 155 participants with a mean age of 58.6 years and average glycosylated hemoglobin A of 8%. After initiating metformin therapy, LDL-C was significantly reduced from 111 mg/dl to 102 mg/dL at 6 months ( < 0.001), TG was reduced from 132 mg/dl to 122 mg/dL at 12 months ( = 0.046), and HDL-C increased from 45.1 mg/dL to 46.9 mg/dL at 12 months ( = 0.02). However, increasing the dosage of metformin yielded no significant effect on its lipid-lowering efficacy.
Metformin monotherapy appreciably improves dyslipidemia in statin-naive people with T2DM. Its lipid-modifying effect may be attributable to insulin sensitization, reduction of irreversibly glycated LDL-C, and weight loss. In practice, people with dyslipidemia who are ineligible for lipid-lowering agents may benefit from metformin therapy. Moreover, previous studies report a synergistic effect between metformin and statin, which may further reduce cardiovascular events in at-risk individuals. Overall, metformin is a safe and efficacious approach to alleviate dyslipidemia in people with newly diagnosed T2DM.
心血管疾病是2型糖尿病（T2DM）患者死亡和发病的主要原因。研究一直将血脂异常确定为大血管疾病发生的重要危险因素。具有里程碑意义的英国前瞻性糖尿病研究表明，二甲双胍治疗可降低超重T2DM患者的心血管事件。本研究调查二甲双胍单药治疗对新诊断的未服用他汀类药物的T2DM患者血脂谱的影响，以及该影响（若有）是否与剂量相关。
本队列研究纳入年龄超过20岁、近期发病的T2DM患者，这些患者接受了至少12个月的二甲双胍单药治疗，并每隔6个月进行血脂血液检测。排除标准包括正在接受任何其他抗糖尿病药物或降脂药物治疗的患者。二甲双胍的调脂作用记录为每隔6个月测量的血清甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平。
该研究纳入了155名参与者，平均年龄为58.6岁，平均糖化血红蛋白A为8%。开始二甲双胍治疗后，6个月时LDL-C从111mg/dl显著降至102mg/dL（P<0.001），12个月时TG从132mg/dl降至122mg/dL（P=0.046），12个月时HDL-C从45.1mg/dL升至46.9mg/dL（P=0.02）。然而，增加二甲双胍剂量对其降脂疗效没有显著影响。
二甲双胍单药治疗可显著改善未服用他汀类药物的T2DM患者的血脂异常。其调脂作用可能归因于胰岛素敏感性增加、不可逆糖化LDL-C的减少以及体重减轻。在实践中，不符合使用降脂药物条件的血脂异常患者可能从二甲双胍治疗中获益。此外，先前研究报告了二甲双胍与他汀类药物之间的协同作用，这可能进一步降低高危个体的心血管事件。总体而言，二甲双胍是一种安全有效的方法，可减轻新诊断的T2DM患者的血脂异常。
