Skip to main content
Top
Published in: Diabetologia 9/2017

Open Access 01-09-2017 | Review

A new perspective on metformin therapy in type 1 diabetes

Authors: Rachel Livingstone, James G. Boyle, John R. Petrie, on behalf of The REMOVAL Study Team

Published in: Diabetologia | Issue 9/2017

Login to get access

Abstract

Metformin is quite frequently used off-label in type 1 diabetes to limit insulin dose requirement. Guidelines recommend that it can improve glucose control in those who are overweight and obese but evidence in support of this is limited. Recently-published findings from the REducing with MetfOrmin Vascular Adverse Lesions (REMOVAL) trial suggest that metformin therapy in type 1 diabetes can reduce atherosclerosis progression, weight and LDL-cholesterol levels. This provides a new perspective on metformin therapy in type 1 diabetes and suggests a potential role for reducing the long-term risk of cardiovascular disease.
Appendix
Available only for authorised users
Literature
1.
go back to reference The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef
2.
go back to reference Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group (2016) Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up. Diabetes Care 39:686–693CrossRef Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group (2016) Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up. Diabetes Care 39:686–693CrossRef
3.
go back to reference McKnight JA, Wild SH, Lamb MJ et al (2015) Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 32:1036–1050CrossRefPubMed McKnight JA, Wild SH, Lamb MJ et al (2015) Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 32:1036–1050CrossRefPubMed
4.
go back to reference Haynes A, Hermann JM, Miller KM et al (2016) Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases. Pediatr Diabetes. doi:10.1111/pedi.12477 Haynes A, Hermann JM, Miller KM et al (2016) Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases. Pediatr Diabetes. doi:10.​1111/​pedi.​12477
5.
go back to reference Cleland SJ, Fisher BM, Colhoun HM, Sattar N, Petrie JR (2013) Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks? Diabetologia 56:1462–1470CrossRefPubMedPubMedCentral Cleland SJ, Fisher BM, Colhoun HM, Sattar N, Petrie JR (2013) Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks? Diabetologia 56:1462–1470CrossRefPubMedPubMedCentral
6.
go back to reference Livingstone SJ, Looker HC, Hothersall EJ et al (2012) Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study. PLoS Med 9:e1001321CrossRefPubMedPubMedCentral Livingstone SJ, Looker HC, Hothersall EJ et al (2012) Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study. PLoS Med 9:e1001321CrossRefPubMedPubMedCentral
7.
8.
go back to reference Petrie JR, Chaturvedi N, Ford I et al (2017) Metformin in adults with type 1 diabetes: design and methods of reducing with metformin vascular adverse lesions (REMOVAL): an international multicentre trial. Diabetes Obes Metab 19:509–516CrossRefPubMedPubMedCentral Petrie JR, Chaturvedi N, Ford I et al (2017) Metformin in adults with type 1 diabetes: design and methods of reducing with metformin vascular adverse lesions (REMOVAL): an international multicentre trial. Diabetes Obes Metab 19:509–516CrossRefPubMedPubMedCentral
9.
go back to reference Petrie JR, Chaturvedi N, Ford I et al (2017) Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(17)30194-8 Petrie JR, Chaturvedi N, Ford I et al (2017) Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. doi:10.​1016/​S2213-8587(17)30194-8
12.
go back to reference Nathan DM, Buse JB, Davidson MB et al (2009) Management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 52:17–30CrossRefPubMed Nathan DM, Buse JB, Davidson MB et al (2009) Management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 52:17–30CrossRefPubMed
13.
go back to reference UK Prospective Diabetes Study Group (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352:854–865CrossRef UK Prospective Diabetes Study Group (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352:854–865CrossRef
14.
go back to reference Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589CrossRefPubMed Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589CrossRefPubMed
15.
go back to reference Gin H, Messerchmitt C, Brottier E, Aubertin J (1985) Metformin improved insulin resistance in type I, insulin-dependent, diabetic patients. Metabolism 34:923–925CrossRefPubMed Gin H, Messerchmitt C, Brottier E, Aubertin J (1985) Metformin improved insulin resistance in type I, insulin-dependent, diabetic patients. Metabolism 34:923–925CrossRefPubMed
16.
go back to reference Keen H, Collins ACG, Bending JJ (1987) Metformin increases response to insulin in type-1 (insulin-dependent) diabetes. Diabetologia 30:A538 (Abstract) Keen H, Collins ACG, Bending JJ (1987) Metformin increases response to insulin in type-1 (insulin-dependent) diabetes. Diabetologia 30:A538 (Abstract)
17.
go back to reference Walravens PA, Chase PH, Klingensmith GJ, Ellison M, Cornell C, Monahan K (2000) Low dose metformin in adolescents with type 1 diabetes mellitus: a double blind, controlled study. Diabetes 49(Suppl 1):A128 Abstract Walravens PA, Chase PH, Klingensmith GJ, Ellison M, Cornell C, Monahan K (2000) Low dose metformin in adolescents with type 1 diabetes mellitus: a double blind, controlled study. Diabetes 49(Suppl 1):A128 Abstract
18.
go back to reference Nadeau KJ, Chow K, Alam S et al (2015) Effects of low dose metformin in adolescents with type I diabetes mellitus: a randomized, double-blinded placebo-controlled study. Pediatr Diabetes 16:196–203CrossRefPubMed Nadeau KJ, Chow K, Alam S et al (2015) Effects of low dose metformin in adolescents with type I diabetes mellitus: a randomized, double-blinded placebo-controlled study. Pediatr Diabetes 16:196–203CrossRefPubMed
19.
go back to reference Meyer L, Bohme P, Delbachian I et al (2002) The benefits of metformin therapy during continuous subcutaneous insulin infusion treatment of type 1 diabetic patients. Diabetes Care 25:2153–2158CrossRefPubMed Meyer L, Bohme P, Delbachian I et al (2002) The benefits of metformin therapy during continuous subcutaneous insulin infusion treatment of type 1 diabetic patients. Diabetes Care 25:2153–2158CrossRefPubMed
20.
go back to reference Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D (2003) Metformin as an adjunct therapy in adolescents with type 1 diabetes and insulin resistance. Diabetes Care 26:138–143CrossRefPubMed Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D (2003) Metformin as an adjunct therapy in adolescents with type 1 diabetes and insulin resistance. Diabetes Care 26:138–143CrossRefPubMed
21.
go back to reference Sarnblad S, Kroon M, Aman J (2003) Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity. Eur J Endocrinol 149:323–329CrossRefPubMed Sarnblad S, Kroon M, Aman J (2003) Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity. Eur J Endocrinol 149:323–329CrossRefPubMed
22.
go back to reference Khan AS, McLoughney CR, Ahmed AB (2006) The effect of metformin on blood glucose control in overweight patients with type 1 diabetes. Diabet Med 23:1079–1084CrossRefPubMed Khan AS, McLoughney CR, Ahmed AB (2006) The effect of metformin on blood glucose control in overweight patients with type 1 diabetes. Diabet Med 23:1079–1084CrossRefPubMed
23.
go back to reference Moon RJ, Bascombe LA, Holt RIG (2007) The addition of metformin in type 1 diabetes improves insulin sensitivity, diabetic control, body composition and patient well-being. Diabetes Obes Metab 9:143–145CrossRefPubMed Moon RJ, Bascombe LA, Holt RIG (2007) The addition of metformin in type 1 diabetes improves insulin sensitivity, diabetic control, body composition and patient well-being. Diabetes Obes Metab 9:143–145CrossRefPubMed
24.
go back to reference Lund SS, Tarnow L, Astrup AS et al (2008) Effect of adjunct metformin treatment in patients with type-1 diabetes and persistent inadequate glycaemic control. A randomized study. PLoS One 3:e3363CrossRefPubMedPubMedCentral Lund SS, Tarnow L, Astrup AS et al (2008) Effect of adjunct metformin treatment in patients with type-1 diabetes and persistent inadequate glycaemic control. A randomized study. PLoS One 3:e3363CrossRefPubMedPubMedCentral
25.
go back to reference Lund SS, Tarnow L, Astrup AS et al (2009) Effect of adjunct metformin treatment on levels of plasma lipids in patients with type 1 diabetes. Diabetes Obes Metab 11:966–977CrossRefPubMed Lund SS, Tarnow L, Astrup AS et al (2009) Effect of adjunct metformin treatment on levels of plasma lipids in patients with type 1 diabetes. Diabetes Obes Metab 11:966–977CrossRefPubMed
26.
go back to reference Vella S, Buetow L, Royle P, Livingstone S, Colhoun H, Petrie JR (2010) The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia 53:809–820CrossRefPubMed Vella S, Buetow L, Royle P, Livingstone S, Colhoun H, Petrie JR (2010) The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia 53:809–820CrossRefPubMed
28.
go back to reference American Diabetes Association (2017) Standards of medical care in diabetes. Diabetes Care 40(Suppl 1):S1–S135 American Diabetes Association (2017) Standards of medical care in diabetes. Diabetes Care 40(Suppl 1):S1–S135
29.
go back to reference Ponssen HH, Elte JW, Lehert P, Schouten JP, Bets D (2000) Combined metformin and insulin therapy for patients with type 2 diabetes mellitus. Clin Ther 22:709–718CrossRefPubMed Ponssen HH, Elte JW, Lehert P, Schouten JP, Bets D (2000) Combined metformin and insulin therapy for patients with type 2 diabetes mellitus. Clin Ther 22:709–718CrossRefPubMed
30.
go back to reference Kooy A, de Jager J, Lehert P et al (2009) Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med 169:616–625CrossRefPubMed Kooy A, de Jager J, Lehert P et al (2009) Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med 169:616–625CrossRefPubMed
31.
go back to reference de Jager J, Kooy A, Schalkwijk C et al (2014) Long-term effects of metformin on endothelial function in type 2 diabetes: a randomized controlled trial. J Intern Med 275:59–70CrossRefPubMed de Jager J, Kooy A, Schalkwijk C et al (2014) Long-term effects of metformin on endothelial function in type 2 diabetes: a randomized controlled trial. J Intern Med 275:59–70CrossRefPubMed
32.
go back to reference Lorenz MW, Polak JF, Kavousi M et al (2012) Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet 379:2053–2062CrossRefPubMedPubMedCentral Lorenz MW, Polak JF, Kavousi M et al (2012) Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet 379:2053–2062CrossRefPubMedPubMedCentral
33.
go back to reference Libman IM, Miller KM, Dimgelio LA et al (2016) Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: a randomized clinical trial. JAMA 314:2241–2250CrossRef Libman IM, Miller KM, Dimgelio LA et al (2016) Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: a randomized clinical trial. JAMA 314:2241–2250CrossRef
34.
go back to reference Nathan DM, Lachin J, Cleary P et al (2003) Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med 348:2294–2303CrossRefPubMed Nathan DM, Lachin J, Cleary P et al (2003) Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med 348:2294–2303CrossRefPubMed
35.
go back to reference Meaney E, Vela A, Samaniego V et al (2008) Metformin, arterial function, intima-media thickness and nitroxidation in metabolic syndrome: the Mefisto study. Clin Exp Pharmacol Physiol 35:895–903CrossRefPubMed Meaney E, Vela A, Samaniego V et al (2008) Metformin, arterial function, intima-media thickness and nitroxidation in metabolic syndrome: the Mefisto study. Clin Exp Pharmacol Physiol 35:895–903CrossRefPubMed
36.
go back to reference Matsumoto K, Gera Y, Abe Y, Tominanga T, Yeki Y, Miyake S (2004) Metformin attenuates progression of carotid arterial wall thickness in patients with type 2 diabetes. Diabetes Res Clin Pract 64:225–228CrossRefPubMed Matsumoto K, Gera Y, Abe Y, Tominanga T, Yeki Y, Miyake S (2004) Metformin attenuates progression of carotid arterial wall thickness in patients with type 2 diabetes. Diabetes Res Clin Pract 64:225–228CrossRefPubMed
37.
go back to reference Preiss D, Lloyd SM, Ford I et al (2014) Metformin for non-diabetic patients with coronary heart disease (the CAMERA study): a randomised controlled trial. Lancet Diabetes Endocrinol 2:116–124CrossRefPubMed Preiss D, Lloyd SM, Ford I et al (2014) Metformin for non-diabetic patients with coronary heart disease (the CAMERA study): a randomised controlled trial. Lancet Diabetes Endocrinol 2:116–124CrossRefPubMed
38.
go back to reference Lundby-Christensen L, Tarnow L, Boesgaard TW et al (2016) Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus-the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial. BMJ Open 6:e008376CrossRefPubMedPubMedCentral Lundby-Christensen L, Tarnow L, Boesgaard TW et al (2016) Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus-the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial. BMJ Open 6:e008376CrossRefPubMedPubMedCentral
39.
go back to reference Touboul PJ, Hennerici MG, Meairs S et al (2012) Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th Watching the Risk Symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 34:290–296CrossRefPubMedPubMedCentral Touboul PJ, Hennerici MG, Meairs S et al (2012) Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th Watching the Risk Symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 34:290–296CrossRefPubMedPubMedCentral
40.
go back to reference Polak JF, Szklo M, Kronmal RA et al (2013) The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis. J Am Heart Assoc 2:e000087CrossRefPubMedPubMedCentral Polak JF, Szklo M, Kronmal RA et al (2013) The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis. J Am Heart Assoc 2:e000087CrossRefPubMedPubMedCentral
41.
go back to reference Bell S, Farran B, McGurnaghan S et al (2017) Risk of acute kidney injury and survival in patients treated with metformin: an observational cohort study. BMC Nephrol 18:163CrossRefPubMedPubMedCentral Bell S, Farran B, McGurnaghan S et al (2017) Risk of acute kidney injury and survival in patients treated with metformin: an observational cohort study. BMC Nephrol 18:163CrossRefPubMedPubMedCentral
42.
go back to reference Boyle JG, Logan PJ, Jones GC et al (2011) AMP-activated protein kinase is activated in adipose tissue of subjects with type 2 diabetes treated with metformin. Diabetologia 54:1799–1809CrossRefPubMed Boyle JG, Logan PJ, Jones GC et al (2011) AMP-activated protein kinase is activated in adipose tissue of subjects with type 2 diabetes treated with metformin. Diabetologia 54:1799–1809CrossRefPubMed
43.
44.
go back to reference Vasamsetti SB, Karnewar S, Kanugula AK, Thatipalli AR, Kumar JM, Kotamraju S (2015) Metformin inhibits monocyte-to-macrophage differentiation via AMPK-mediated inhibition of STAT3 activation: potential role in atherosclerosis (2015). Diabetes 64:2028–2041CrossRefPubMed Vasamsetti SB, Karnewar S, Kanugula AK, Thatipalli AR, Kumar JM, Kotamraju S (2015) Metformin inhibits monocyte-to-macrophage differentiation via AMPK-mediated inhibition of STAT3 activation: potential role in atherosclerosis (2015). Diabetes 64:2028–2041CrossRefPubMed
45.
go back to reference Morrow VA, Foufelle F, Connell JM, Petrie JR, Gould GW, Salt IP (2003) Direct activation of AMP-activated protein kinase stimulates nitric-oxide synthesis in human aortic endothelial cells. J Biol Chem 278:31629–31639CrossRefPubMed Morrow VA, Foufelle F, Connell JM, Petrie JR, Gould GW, Salt IP (2003) Direct activation of AMP-activated protein kinase stimulates nitric-oxide synthesis in human aortic endothelial cells. J Biol Chem 278:31629–31639CrossRefPubMed
46.
go back to reference Beisswenger PJ (2014) Methylglyoxal in diabetes: link to treatment, glycaemic control and biomarkers of complications. Biochem Soc Trans 42:450–456CrossRefPubMed Beisswenger PJ (2014) Methylglyoxal in diabetes: link to treatment, glycaemic control and biomarkers of complications. Biochem Soc Trans 42:450–456CrossRefPubMed
Metadata
Title
A new perspective on metformin therapy in type 1 diabetes
Authors
Rachel Livingstone
James G. Boyle
John R. Petrie
on behalf of The REMOVAL Study Team
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia / Issue 9/2017
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-017-4364-6

Other articles of this Issue 9/2017

Diabetologia 9/2017 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.