| Autor: |
Kooy, Adriaan, De Jager, Jolien, Lehert, Philippe, Bets, Daniël, Wulffelé, Michiel G., Donker, A. B. J., Stehouwer, Coen D. |
| Předmět: |
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| Zdroj: |
Diabetes; Jun2007 Supplement 1, Vol. 56, pA154-A154, 1/3p, 1 Graph |
| Abstrakt: |
Introduction: Of all antihyperglycemic agents, only metformin has been shown to decrease cardiovascular morbidity and mortality. The mechanisms through which metformin decreases the risk of cardiovascular disease remain unclear. We hypothesized that, in patients with type 2 diabetes intensively treated with insulin, metformin will have sustained beneficial metabolic effects, and thus decrease cardiovascular morbidity. Methods: The HOME trial is a double-blind, multicenter trial, in which all patients (n=390) were randomized to receive either metformin or placebo added to insulin therapy. Effects of metformin on metabolic and disease-related endpoints were studied during 4.3 years. Results: Metformin treatment prevented weight gain (difference summary mean = 3.07 kg [2.28 to 3.85; p<0.001]), improved glycemic control -- despite the aim to achieve comparable glycemic control in both groups -- (difference summary mean HbA1c = 0.40%-point [0.25 to 0.55; p<0.001]), and reduced insulin requirements (difference summary mean = 19.63 IU/day [14.36 to 24.91; p<0.001] or 0.18 IU/kg [0.12 to 0.23; p<0.001]). Metformin treatment was not associated with an improvement in the primary, cardiovascular endpoint (= microvascular endpoint + macrovascular endpoint + sudden death (hazard ratio 0.92 [0.67 to 1.27; p=0.34]), but it was associated with a decreased risk of the secondary, macrovascular endpoint (hazard ratio 0.61 [0.40 to 0.94; p=0.02; see figure]). Conclusions: In type 2 diabetic patients treated with insulin, addition of metformin resulted in sustained improvements in weight, glycemic control, and insulin requirements, and, moreover, in a reduced risk of macrovascular disease. The results of our study show that type 2 diabetic patients can profit greatly if metformin treatment is continued after the introduction of insulin and suggest a shift in the current treatment guidelines. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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