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Diabetologia
Published in: Diabetologia 5/2010

01-05-2010 | Review

The use of metformin in type 1 diabetes: a systematic review of efficacy

Authors: S. Vella, L. Buetow, P. Royle, S. Livingstone, H. M. Colhoun, J. R. Petrie

Published in: Diabetologia | Issue 5/2010

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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.
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Metadata
Title
The use of metformin in type 1 diabetes: a systematic review of efficacy
Authors
S. Vella
L. Buetow
P. Royle
S. Livingstone
H. M. Colhoun
J. R. Petrie
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 5/2010
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-009-1636-9

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