Combined metformin-sulfonylurea treatment of patients with noninsulin-dependent diabetes in fair to poor glycemic control
| Autor: | Clarie B Hollenbeck, R. Skowronski, P. Johnston, Gerald M. Reaven, I D Goldfine, J C Zhang, Yi Chen |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty medicine.drug_class Endocrinology Diabetes and Metabolism Glucose uptake medicine.medical_treatment Clinical Biochemistry Fatty Acids Nonesterified Biochemistry Endocrinology Internal medicine Diabetes mellitus Humans Insulin Medicine Triglycerides Glycemic business.industry Cholesterol HDL Biochemistry (medical) Middle Aged medicine.disease Sulfonylurea Metformin Sulfonylurea Compounds Postprandial Diabetes Mellitus Type 2 Basal (medicine) Drug Therapy Combination Female business medicine.drug |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 74:1020-1026 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/jcem.74.5.1569149 |
| Popis: | The effect of metformin treatment was studied in 13 patients with noninsulin-dependent diabetes mellitus (NIDDM), whose fasting plasma glucose concentration was greater than 10 mmol/L with maximal sulfonylurea doses. Patients were studied before and 3 months after receiving 2.5 g/day metformin. The fasting plasma glucose concentration (12.4 +/- 0.8 vs. 8.8 +/- 0.7 mmol/L), mean hourly postprandial plasma glucose concentration from 0800-1600 h (14.0 +/- 1 vs. 9.4 +/- 0.9 mmol/L), and glycosylated hemoglobin level (12.3 +/- 0.6% vs. 9.0 +/- 0.6%) were all significantly (P less than 0.005-0.001) lower after the administration of metformin. The improvement in glycemic control was associated with a 24% increase (P less than 0.05) in insulin-stimulated glucose uptake during glucose clamp studies and a 16% decrease in basal hepatic glucose production (P less than 0.05). Mean hourly concentrations of plasma insulin (411 +/- 73 vs. 364 +/- 73 pmol/L) and FFA concentrations (440 +/- 31 vs. 390 +/- 40 mumol/L) were also lower after 3 months of metformin treatment. However, neither insulin binding nor insulin internalization by isolated monocytes changed in response to metformin. Finally, plasma triglyceride, very low density lipoprotein triglyceride, and very low density lipoprotein cholesterol were significantly decreased (P less than 0.01-0.001), and high density lipoprotein cholesterol was significantly increased (P less than 0.001) after metformin treatment. Thus, the addition of metformin to sulfonylurea-treated patients with NIDDM not in good glycemic control significantly lowered fasting and postprandial plasma glucose concentrations, presumably due to the combination of enhanced glucose uptake and decreased hepatic glucose production. Since the dyslipidemia present in these patients also improved, the results suggest that metformin may be of significant clinical utility in patients with NIDDM not well controlled with sulfonylurea compounds. |
| Databáze: | OpenAIRE |
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