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Effects of Metformin on Type 2 Diabetes

Metformin seems to have positive effects on body composition, insulin sensitivity, and glucose homeostasis in patients recently diagnosed with type 2 diabetes…. 

Metformin is a widely accepted first line agent for type 2 diabetes. It acts primarily at the liver site by reducing glucose output and, secondarily, by enhancing glucose uptake in the peripheral tissues. Metformin also induces some weight loss in adults with diabetes which might be due to a reduction in insulin resistance.

In this prospective, non-interventional, observational study, researchers primarily looked at patients who were recently diagnosed with type 2 diabetes and on metformin. A total of 51 patients with mean age of 52.67 years were evaluated for changes in body composition, insulin sensitivity, insulin resistance, and metabolic control for 6 months. Patients were taking 1000 mg metformin, twice daily. The level of physical activity remained unchanged during this study period. Forty-one patients completed the study. Patients were measured for weight, height, BMI, abdominal and hip circumferences, and waist to hit ratio. Also, total body scans were done at baseline and 24 weeks after initiation of metformin therapy.

Researchers found a significant decrease in total fat mass due to metformin treatment (CI = -2.39; P=0.000). By the end of 6 months study, patients showed an increase in lean-to-fat ratio (CI=0.005 to 0.1999; P=0.04), mainly in men. Skeletal muscle index increased by week 24 (P=0.02), more in men compared to women patients. The researchers also showed loss of muscle tissue, sarcopenia, in 20% of the female patients (P=0.001 at baseline; P=0.004 at week 24), with no significant differences. A significant improvement in glucose homeostasis, A1C (CI= 1.99; P=0.0001) and insulin sensitivity (CI=0.027; P=0.03) was observed with metformin treatment.

Overall this study showed that metformin has significant positive effects on body composition, insulin sensitivity, and glucose homeostasis after 6 months of treatment.

Practice Pearls:
  • Metformin is a first line agent for type 2 diabetes
  • Metformin showed decreased total fat mass, increased in lean-to-fat ratio in men. Metformin is also expected to postpone sarcopenia, especially in women with type 2 diabetes who are at higher risk for loss of skeletal muscle.
  • Metformin also showed positive effects on insulin sensitivity and glucose homeostasis.

Aghili, Rokhsareh, et al. "BodyComposition in Adults with Newly Diagnosed Type 2 Diabetes: Effects of Metformin." BioMed Central. Journal of Diabetes & Metabolic Disorders, 21 Aug. 2014. Web. http://www.jdmdonline.com/content/pdf/s40200-014-0088-z.pdf