In youth with T1D, metformin holds CVD-protective promise

  • Circulation

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Young people with type 1 diabetes (T1D) experience improved insulin resistance (IR) after 3 months of taking metformin, regardless of BMI, aortic/carotid factors, or insulin dose.
  • These youth have early signs of cardiovascular disease (CVD) compared with their unaffected peers in the EMERALD trial.

Why this matters

  • The authors say their findings point to metformin as CVD protective.

Key results

  • T1D group had altered aortic measures vs control group.
  • Glucose infusion rate/insulin (M/I)/kg better with drug vs placebo, adjusted for sex, puberty, BMI change:
    • 11.5±3.4 vs −1.3±3.91 mg/kg/minute (P=.03).
  • M/I also improved per lean kilogram with metformin vs placebo, with adjustment:
    • 7.4±9.6 vs −14.3±9.8 mg/lean kg/minute (P=.01).
  • Metformin offered improvements vs placebo in:
    • body weight (−0.5±0.5 vs 1.6±0.5 kg; P=.004), 
    • BMI (−0.2±0.15 vs 0.4±0.15 kg/m2; P=.005), and 
    • fat mass (−0.7±0.3 vs 0.6±0.4 kg; P=.01).
  • Groups did not differ for HbA1c, BP, cholesterol, triglycerides.
  • Aortic parameters improved with metformin vs placebo:
    • stiffness: P=.04; and
    • wall shear stress: P=.03.
  • Adherence 93% in both groups.
  • Adverse events: minor gastrointestinal complaints.

Study design

  • N=48 with T1D (ages 12-21 years) vs 24 without T1D.
  • Outcomes: IR, aortic parameters, lipids, body weight.
  • Funding: NIH; others.

Limitations

  • Brief, small, limited population.

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