Ramaldes Luana A L, Dos Santos Sarah S, Dualib Patricia M, de Sa Joao R, Dib Sérgio A
Department of Medicine, Division of Endocrinology, Diabetes Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Caixa Postal 20266 CEP 04022-001, Brazil.
Division of Medicine-Endocrinology, ABC School of Medicine, São Paulo, Brazil.
Diabetol Metab Syndr. 2024 Sep 2;16(1):214. doi: 10.1186/s13098-024-01451-4.
This study aimed to investigate whether the response to adding metformin to insulin in young adults with type 1 diabetes (T1D) differs according to weight phenotype and insulin sensitivity index.
A prospective pilot study was conducted over 26 weeks in which insulin plus metformin (2 g/day) was administered to 35 individuals, ranging from normal weight (NW) to overweight (OW) to obese (OB) T1D individuals, to correlate insulin sensitivity indices and other clinical variables.
At the end of the follow-up period, all groups showed an increase in the eGDR (NW: 7.37 vs 8.16, p = 0.002; OW: 7.28 vs 8.24, p < 0.001; OB: 6.33 vs 7.52 p < 0.001). K and SEARCH SCORE improved only in the OB group (2.15 vs 3.14, p < 0.001 and 5.26 vs 5.72, p = 0.007, respectively). Furthermore, HbA1c and BMI were significantly greater in the OB group (- 0.62%, p < 0.001; - 1.12 kg/m, p = 0.031, respectively). Regression analysis revealed that the serum levels of triglycerides and uric acid were significantly (0.059, p = 0.013; 0.076, p = 0.001) associated with insulin sensitivity indices.
The study showed that eGDR improved independently of basal weight after metformin treatment. However, the K and SEARCH indices improved only in the obese group. Triglycerides and uric acid are associated with insulin sensitivity indices. These results highlight the heterogeneity of the mechanisms underlying insulin resistance and its response to metformin in individuals with T1D.
本研究旨在调查在1型糖尿病（T1D）青年患者中，根据体重表型和胰岛素敏感性指数，加用二甲双胍至胰岛素治疗后的反应是否存在差异。
进行了一项为期26周的前瞻性试点研究，将胰岛素加二甲双胍（2克/天）给予35名个体，范围从正常体重（NW）到超重（OW）再到肥胖（OB）的T1D患者，以关联胰岛素敏感性指数和其他临床变量。
在随访期结束时，所有组的估算肾小球滤过率（eGDR）均有所增加（NW组：7.37对8.16，p = 0.002；OW组：7.28对8.24，p < 0.001；OB组：6.33对7.52，p < 0.001）。K和SEARCH评分仅在OB组有所改善（分别为2.15对3.14，p < 0.001；5.26对5.72，p = 0.007）。此外，OB组的糖化血红蛋白（HbA1c）和体重指数（BMI）显著更高（分别为 - 0.62%，p < 0.001； - 1.12千克/平方米，p = 0.031）。回归分析显示，甘油三酯和尿酸的血清水平与胰岛素敏感性指数显著相关（分别为0.059，p = 0.013；0.076，p = 0.001）。
该研究表明，二甲双胍治疗后eGDR的改善与基础体重无关。然而，K和SEARCH指数仅在肥胖组有所改善。甘油三酯和尿酸与胰岛素敏感性指数相关。这些结果突出了T1D患者中胰岛素抵抗及其对二甲双胍反应的潜在机制的异质性。
