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The use of metformin in type 1 diabetes : a systematic review of efficacy
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Vella, S., Buetow, L., Royle, Pamela, Livingstone, S., Colhoun, H. M. and Petrie, J. R. (2010) The use of metformin in type 1 diabetes : a systematic review of efficacy. Diabetologia, Vol.53 (No.5). pp. 809-820. doi:10.1007/s00125-009-1636-9 ISSN 0012-186X.
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Official URL: http://dx.doi.org/10.1007/s00125-009-1636-9
Abstract
Aims/hypothesis
As adding metformin to insulin therapy has been advocated in type 1 diabetes, we conducted a systematic review of published clinical trials and clinical trial databases to assess the effects on HbA1c, weight, insulin-dose requirement and adverse effects.
Methods
We constructed evidence tables and fitted a fixed-effects model (inverse variance method) in order to assess heterogeneity between studies and give a crude measure of each overall treatment effect.
Results
Of 197 studies identified, nine involved randomisation with informed consent of patients with type 1 diabetes to metformin (vs placebo or comparator) in either a parallel or crossover design for at least 1 week. We noted marked heterogeneity in study design, drug dose, age of participants and length of follow-up. Metformin was associated with reductions in: (1) insulin-dose requirement (5.7–10.1 U/day in six of seven studies); (2) HbA1c (0.6–0.9% in four of seven studies); (3) weight (1.7–6.0 kg in three of six studies); and (4) total cholesterol (0.3–0.41 mmol/l in three of seven studies). Metformin was well tolerated, albeit with a trend towards increased hypoglycaemia. Formal estimates of combined effects from the five trials which reported appropriate data indicated a significant reduction in insulin dose (6.6 U/day, p < 0.001) but no significant reduction in HbA1c (absolute reduction 0.11%, p = 0.42). No reported trials included cardiovascular outcomes.
Conclusions/interpretation
Metformin reduces insulin-dose requirement in type 1 diabetes but it is unclear whether this is sustained beyond 1 year and whether there are benefits for cardiovascular and other key clinical outcomes.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Diabetologia | ||||
Publisher: | Springer | ||||
ISSN: | 0012-186X | ||||
Official Date: | 2010 | ||||
Dates: |
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Volume: | Vol.53 | ||||
Number: | No.5 | ||||
Page Range: | pp. 809-820 | ||||
DOI: | 10.1007/s00125-009-1636-9 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published |
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