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Metformin improves metabolic profile in adults without diabetes on glucocorticoids
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Adults without diabetes on glucocorticoid therapy who were randomly assigned to concomitant metformin therapy saw an improved glycemic profile at 4 weeks vs. those assigned a placebo, study findings show.
“Metformin seems to be a promising drug for preventing metabolic side effects during systemic glucocorticoid treatment,” Mirjam Christ-Crain, MD, PhD, head of the department of clinical research at University Hospital Basel, University of Basel, Switzerland, told Endocrine Today. “Metformin could be given as preventive treatment in patients with glucocorticoid treatment, especially in high-risk patients for metabolic complications, such as weight gain, glucose intolerance and diabetes.”
In a randomized, double blind study, Christ-Crain and colleagues analyzed data from 29 patients without diabetes initiating glucocorticoid treatment for at least 4 weeks ( 7.5 mg prednisone, prednisolone and methylprednisolone), recruited from University Hospital Basel and Cantonal Hospital Aarau between August 2010 and March 2015. Researchers randomly assigned patients to 850 mg metformin once daily for 1 week, followed by 850 mg twice daily for 3 weeks (n = 17), or matching placebo (n = 12). Baseline glucocorticoid doses were similar between groups. Patients underwent a 2-hour, 75-g oral glucose tolerance test at 4 weeks and provided fasting blood and urine samples. Primary endpoint was chance in area under the concentration-time curve (AUC) for glucose during the OGTT between baseline and 4 weeks.
Patients in the metformin group maintained their 2-hour AUC glucose during the study (P = .83), whereas patients in the placebo group experienced an increase (P = .01), according to the researchers; results persisted after adjustment for sex, cumulative glucocorticoid dose and HbA1c. There were no between-group differences for HbA1c during the study period (P = .64).
Researchers did not observe an effect on lipid profile for patients treated with metformin. There were no between-group differences for fasting triglycerides, HDL cholesterol or LDL cholesterol, although the HDL increase that occurred in both groups was more pronounced in those receiving metformin (P = .04), the researchers noted. There were no between-group differences for BMI, waist-to-hip ratio, free fat mass and fat mass.
“Our results indicate that metformin prevents deterioration of glucose metabolism if treatment is timed with initiation of glucocorticoids,” the researchers wrote. “This study provides the basis for metformin as a preventive treatment in patients newly receiving glucocorticoid therapy. Further studies are needed to test if occurrence of glucocorticoid-induced diabetes can be reduced, and if metformin has similar beneficial effects in patients with continuous glucocorticoid treatment.” – by Regina Schaffer
Disclosure: The Swiss National Research Fund supported this study. The researchers report no relevant financial disclosures.
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