二甲双胍联合胰岛素对超重/肥胖 1 型糖尿病患者血糖变异性的影响。

Effects of metformin on glycaemic variability in combination with insulin in overweight/obese patients with type 1 diabetes.

机构信息

Endocrinology Unit, Department of Medicine, Hospital Melaka, Melaka, Malaysia.

Endocrinology Unit, Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

出版信息

J R Coll Physicians Edinb. 2023 Jun;53(2):94-103. doi: 10.1177/14782715231170958. Epub 2023 May 8.

DOI:10.1177/14782715231170958

PMID:37154572

Abstract

BACKGROUND

The prevalence of overweight and obesity in type 1 diabetes mellitus (T1DM) individuals is increasing. Overweight people with T1DM may be insulin resistant. Glycaemic variability (GV) is an emerging measure of glycaemic control. The aim of this study is to investigate whether metformin, in adjunct to insulin, would have any favourable effect on GV.

METHODS

This was a multi-centre, open-label randomised crossover study. Twenty-four overweight/obese T1DM patients aged ⩾18 years old with HbA1c ⩾ 7.0% (53 mmol/mol) were recruited and randomised into two study arms. For first 6-week, one arm remained on standard of care (SOC), the other arm received metformin, adjunctive to SOC. After 2-week washout, patients crossed over and continued for another 6 weeks. Glycaemic variability, other glycaemic parameters and metabolic profile were monitored.

RESULTS

There were significant reduction in metformin group for GV: mean (0.18 ± 1.73 vs -0.95 ± 1.24, = 0.014), %CV (-15.84 (18.92) vs -19.08 (24.53), = 0.044), glycemic risk assessment of diabetes equation (-0.69 (3.83) vs -1.61 (3.61), = 0.047), continuous overlapping net glycaemic action (0.25 ± 1.62 vs -0.85 ± 1.22, = 0.013), J-index (-0.75 (21.91) vs -7.11 (13.86), = 0.034), time in range (1.13 ± 14.12% vs 10.83 ± 15.47%, = 0.032); changes of systolic blood pressure (2.78 ± 11.19 mmHg vs -4.30 ± 9.81 mmHg, = 0.027) and total daily dose (TDD) insulin (0.0 (3.33) units vs -2.17 (11.45) units, = 0.012). Hypoglycaemic episodes were not significant in between groups.

CONCLUSION

Metformin showed favourable effect on GV in overweight/obese T1DM patients and reduction in systolic blood pressure, TDD insulin, fasting venous glucose and fructosamine.

摘要

背景

1 型糖尿病（T1DM）患者超重和肥胖的患病率正在上升。超重的 T1DM 患者可能存在胰岛素抵抗。血糖变异性（GV）是一种新兴的血糖控制衡量指标。本研究旨在探讨二甲双胍联合胰岛素是否对 GV 有任何有利影响。

方法

这是一项多中心、开放标签、随机交叉研究。招募了 24 名年龄 ⩾18 岁、糖化血红蛋白 ⩾7.0%（53mmol/mol）的超重/肥胖 T1DM 患者，并将其随机分为两组。在前 6 周，一组继续接受标准治疗（SOC），另一组接受二甲双胍联合 SOC。在 2 周洗脱期后，患者交叉并继续治疗 6 周。监测血糖变异性、其他血糖参数和代谢特征。

结果

在接受二甲双胍治疗的患者中，GV 显著降低：平均（0.18 ± 1.73 对 -0.95 ± 1.24， = 0.014），%CV（-15.84（18.92）对 -19.08（24.53）， = 0.044），糖尿病方程血糖风险评估（-0.69（3.83）对 -1.61（3.61）， = 0.047），连续重叠净血糖作用（0.25 ± 1.62 对 -0.85 ± 1.22， = 0.013），J 指数（-0.75（21.91）对 -7.11（13.86）， = 0.034），时间在范围内（1.13 ± 14.12%对 10.83 ± 15.47%， = 0.032）；收缩压（2.78 ± 11.19mmHg 对 -4.30 ± 9.81mmHg， = 0.027）和总日剂量（TDD）胰岛素（0.0（3.33）单位对 -2.17（11.45）单位， = 0.012）也有变化。两组之间的低血糖发作没有显著差异。