Update on metformin

Exploring the cardiovascular and metabolic effects of metformin in patients with type 1 diabetes

Metformin is an oral diabetes medication that helps control blood sugar levels and is associated with cardiovascular benefit in people with type 2 diabetes. Since heart disease is also a major cause of decreased life expectancy in individuals living with type 1 diabetes (T1D), researchers are now experimenting with metformin in the treatment of T1D. Currently, the United States’ and United Kingdom’s guidelines recommend combining metformin with insulin therapy in overweight or obese individuals with T1D to improve glucose control and reduce the amount of insulin required on a daily basis.

REMOVAL was the largest and longest trial of metformin studying individuals living with T1D. It involved 23 diabetes clinics in five countries: Canada (The Ottawa Hospital Research Institute and St. Joseph’s Health Care in London, Ontario), Australia, Denmark, the Netherlands and the United Kingdom. Funded by JDRF’s Canadian Clinical Trials Network (CCTN), the study followed 93 participants (aged 40 years and older with T1D for at least five years and a minimum of three out of 10 cardiovascular risk factors) who were randomly assigned to either a placebo or a 1,000 mg dose of metformin twice daily. The aim was to determine whether treatment with metformin reduced atherosclerosis – hardening and narrowing of the arteries – in those at increased risk for heart disease.

Among their findings, investigators confirmed favourable effects on body weight, as well as evidence of decreased insulin requirement and atherosclerosis progression for those taking metformin. The study was also the first to show a sustained lowering in cholesterol among people with T1D who were treated with statins (drugs that reduce levels of fats in the blood).

“Collaborative international clinical trials are a powerful tool in evaluating new approaches to treat and prevent T1D,” says Dave Prowten, President and CEO of JDRF Canada. “Working together with our global research partners, we can accelerate this type of transformative research and ensure the project delivers results that will make a real difference to people living with T1D.”

 

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