Regístrese
Buscar en
Endocrinología y Nutrición
Toda la web
Inicio Endocrinología y Nutrición Effect of metformin on cardiovascular risk factors in obese type 2 diabetic pati...
Información de la revista
Vol. 48. Núm. 4.
Páginas 110-113 (Abril 2001)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 48. Núm. 4.
Páginas 110-113 (Abril 2001)
DOI: 10.1016/S1575-0922(01)73514-0
Acceso a texto completo
Effect of metformin on cardiovascular risk factors in obese type 2 diabetic patients
Efecto de la metformina en los factores de riesgo cardiovasculares en pacientes obesos con diabetes tipo 2
Visitas
2454
D.A. De Luis*, L. Cuéllar, C. Terroba, R. Aller, D. Bellido, G. Piédrola, A. Becerra
Institute of Endocrinology and Nutrition. Medicine School and Hospital Río Hortega. Univesity of Valladolid. Valladolid. Spain
Este artículo ha recibido
2454
Visitas
Información del artículo
Background

Obese patients with type 2 diabetes mellitus often are in poor glycaemic control. Weight gain, hyperlipidemia and hypertension accompain insulin therapy in these patients.

Objective

The aim of our study was to evaluate the effect of metformin on these parameters in obese type 2 diabetic patients previously treated with other therapies.

Design

A group of 78 type 2 diabetic outpatients in poor glycaemic control (HbA1c > 7.5%) and overweight (BMI > 25) were analyzed prospectively. All patients were treated with metformin during three months in a step up dosage schedule. Anti-hypertensive and anti-lipid therapy remained unchanged during the study. All patients remained with the same dietary intake (1.500 calories) and exercise.

Results

A decrease in basal glucose (24.8%) (173 ± 29.8 mg/dl vs 134.8 ± 21.4 mg/dl; p < 0.001) and HbA1c levels (15.4%) (8.5 ± 1.4% vs 7.2 ± 1.1%; p < 0.001) were achieved with a decrease in the number of hypoglycaemias, dose of insulin (39%) (0.39 ± 0.12 UI/kg/day vs 0.29 ± 0.08 UI/kg/day; p < 0.005) and dose of sulfonylurea (gliclazide) (46%) (107.5 ± 119 mg/day vs 57.5 ± 92 mg/day; p < 0.001). UP to 25.6% of the patients stopped the previous drug therapy achieving good control with metformin alone (HbA1c < 6.5%). Cardiovascular risk factors improved with a significant decrease in LDL (12.9%) (147.3 ± 33.7 mg/dl vs 128.8 ± 28.6 mg/dl; p < 0.05), total cholesterol (8.5%) (224.6 ± 126.9 mg/dl vs 205.3 ± 34.5 mg/dl; p < 0.01), triglycerides levels (13.7%) (139.8 ± 57 mg/dl vs 120.1 ± 42.7 mg/dl; p < 0.001) without changes in HDL. Blood pressure improved, with a significant decrease in systolic (5%) (137.9 ± 27 mmHg vs 130.7 ± 20; p < 0.01) and diastolic (9.4%) (85 ± 10 mmHg vs 79.3 ± 14 mmHg; p < 0.01) pressure. No patient dropped out the treatment due to side effects and the weight did not change.

Conclusions

In summary, the addition of metformin improved glycaemic, lipid and blood pressure control in obese diabetic type 2 patients in por glycemic control with a low incidence of side effects.

Palabras clave:
Metformina
Diabetes mellitus tipo 2
Obesidad
Introducción

Los pacientes con diabetes mellitus tipo 2 y obesidad con frecuencia presentan un mal control glucémico. El exceso de peso, la hiperlipemia y la hipertensión a menudo acompañan a la terapia con insulina en estos pacientes.

Objetivo

El objetivo principal de nuestro estudio fue evaluar el efecto de la metformina en pacientes obesos con diabetes tipo 2 previamente tratados con otras terapias hipoglucemiantes. Diseño. Se estudiaron de manera prospectiva un grupo de 78 diabéticos tipo 2 con mal control glucémico (hemoglobina glucosilada [HbA1c] > 7,5%) y sobrepeso (índice de masa corporal [IMC] > 25). Todos los pacientes recibieron metformina durante 3 meses en un esquema ascendente. La terapia antihipertensiva e hipolipemiante permaneció invariable durante el estudio; asimismo, todos los pacientes recibieron una dieta de 1.500 calorías y realizaron su programa de ejercicios habitual.

Resultados

Se alcanzó un descenso en los valores de glucosa (24,8%) (173,1 ± 29,8 mg/dl frente a 134,8 ± 21,4 mg/dl; p < 0,001) y HbA1c (15,4%) (8,5 ± 1,4% frente a 7,2 ± 1,1%; p < 0,001), con una disminución en el número de hipoglucemias y de la dosis recibida de insulina (39%) (0,39 ± 0,12 U/kg/día frente a 0,29 ± 0,08 U/kg/día; p < 0,005) y sulfonilurea (gliclazida) (46%) (107,5 ± 119 mg/día frente a 57,5 ± 92 mg/día; p < 0,01). A un 25,6% pacientes se les suspendió la medicación previa presentando un buen control glucémico sólo con metformina (HbA1c < 6,5%). Los factores de riesgo cardiovascular mejoraron, con un descenso en los valores de lipoproteínas de baja densidad (LDL) (12,9%) (147,3 ± 33,7 mg/dl frente 128,8 ± 28,6 mg/dl; p < 0,05), colesterol total (8,5%) (224,6 ± 26,9 mg/dl frente a 205,3 ± 34,5 mg/dl; p < 0,01) y triglicéridos (13,7%) (139,8 ± 57 mg/dl frente a 120,1 ± 42,7 mg/dl; p < 0,001), sin cambios en los valores de lipoproteínas de alta densidad (HDL). La presión arterial mejoró, con un descenso significativo de la presión arterial sistólica (5%) (137,9 ± 27 mmHg frente a 130,7 ± 20 mmHg; p < 0,01) y diastólica (9,4%) (85 ± 10 mmHg frente a 79,3 ± 14 mmHg; p < 0,01). Durante el estudio, el peso no cambió y ningún paciente abandonó por efectos secundarios.

Conclusiones

La metformina mejora el control glucémico, lipídico y de presión arterial en pacientes obesos con diabetes tipo 2 y mal control metabólico, con una baja incidencia de efectos secundarios.

Key words:
Metformin
Type 2 diabetes mellitus
Obesity
El Texto completo está disponible en PDF
Biblografía
[1.]
A. Melander.
Oral antidiabetic drugs: an overview.
Diabet Med, 13 (1996), pp. S143-S147
[2.]
R. Turner, C. Cull, R. Holman.
United Kingdom prospective diabetes study 17: a 9-year update of a randomized, controlled trial on the effect of improved metabolic control and complications in non-insulin-dependent diabetes mellitus.
Ann Intern Med, 124 (1996), pp. 136-145
[3.]
R.A. De Fronzo, A.M. Goodman.
Multicenter Metformin study Group: Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus.
N Engl J Med, 333 (1995), pp. 541-549
[4.]
C.J. Bailey, R.C. Turner.
Metformin.
N Engl J Med, 334 (1996), pp. 574-579
[5.]
H.D. McIntyre, A. Ma, D.M. Bird, C.A. Paterson, P.J. Ravenscroft, D.P. Cameron.
Metformin increases insulin sensitivity and basal glucose clearance in type 2 (non-insulin dependent) diabetes mellitus.
Aust N Z J Med, 21 (1991), pp. 714-719
[6.]
D. Giugliano, A. Quatraro, G. Consoli, A. Minei, A. Ceriello, N. De Rosa.
Metformin for obese, insulin-treated diabetic patients improvement in glycaemic control and reduction of metabolic risk factors.
Eur J Clin Pharmacol, 44 (1993), pp. 107-112
[7.]
R.S. Sitori, C. Pasik.
Re-evaluation of a biguanide, metformin: mechanism of action and tolerability.
Pharmacol Res, 30 (1994), pp. 187-228
[8.]
A.J. Garber, T.G. Duncan, A.M. Goodman, D.J. Mills, J.L. Rohlf.
Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled dose response trial.
Am J Med, 102 (1997), pp. 491-497
[9.]
R.A. De Fronzo, N. Barzilai, D.C. Simonson.
Mechanism of Metformin action in obese and lean non insulin-dependent diabetic subjects.
J Clin Endocrinol Metab, 73 (1991), pp. 1294-1301
[10.]
L. Avilés Santa, J. Sinding, P. Raskin.
Effects of Metformin in patients with poorly controlled, insulin-treated type 2 diabetes mellitus.
Ann Intern Med, 131 (1999), pp. 182-188
[11.]
M.S. Muntzel, I. Hamidou, S. Barret.
Metformin attenuates salt-induced hypertension in spontaneously hypertensive rats.
Hypertension, 33 (1999), pp. 1135-1140
[12.]
G. Pagano, V. Tagliaferro, Q. Carta, M.T. Caselle, C. Bozzo, F. Vitelli.
Metformin reduces insulin requirements in type 1 (insulin dependent) diabetes.
Diabetologia, 24 (1983), pp. 351-354
[13.]
UKPDS 24. 6-year, randomized, controlled trial comparing sulfonylurea, insulin, and metformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy. UKPDS group.
Ann Intern Med, 128 (1998), pp. 165-175
[14.]
S. Genuth.
Exogenous insulin administration and cardiovascular risk in non-insulin-dependent and insulin-dependent diabetes mellitus.
Ann Intern Med, 124 (1996), pp. 104-109
[15.]
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and complications Trial Research Group.
N Engl J Med, 329 (1993), pp. 977-986
[16.]
G.M. Reaven, P. Johnston, C.B. Hollenbeck, R. Skwronski, J.C. Zhang, I.D. Goldfine.
Combined metformin-sulfonylurea treatment of patients with noninsulin-dependent diabetes in fair to poor glycemic control.
J Clin Endocrinol Metab, 74 (1992), pp. 1020-1026
[17.]
A.C. Robinson, J. Burke, S. Robinson, D.G. Johnston, R.S. Elkes.
The effects of metformin on glycemic control and serum lipids in insulin-treated NIDDM patients with suboptimal metabolic control.
Diabetes Care, 21 (1998), pp. 701-705
[18.]
J. Jeppesen, M.Y. Zhou, Y.D. Chen, G.M. Reaven.
Effect of metformin on postprandial lipemia in patients with fairly to poorly controlled NIDDM.
Diabetes Care, 17 (1994), pp. 1093-1099
[19.]
S. Muntoni.
Metformin and fatty acids.
Diabetes Care, 22 (1999), pp. 179-180
[20.]
F. Gregorio, F. Ambrosi, S. Mafrini, A. Santucci, P. Filipponi.
Metformin, plasma glucose and free fatty acids in type II diabetic out-patients: results of a clinic study.
Diabetes Res Clin Pract, 37 (1997), pp. 21-33
[21.]
A. Gustafson, P. Bjorntorp, M. Fahlen.
Metformin administration in hyperlipemic states.
Acta Med Scand, 190 (1997), pp. 491-494
[22.]
A. Fontbonne, M.A. Charles, I. Juhan-Vague, J.M. Bard, P. Andre, F. Isnard.
The effect of metformin on the metabolic abnormalities associated with upper-body fat distribution. BIGPRO Study Group.
Diabetes Care, 19 (1996), pp. 920-926
[23.]
J.S. Petersen, G.F. Di Bona.
Effects of central metformin administration on responses to air-jet stress and on arterial baroreflex function in spontaneously hypertensive rats.
J Hypertens, 15 (1997), pp. 285-291
[24.]
X.L. Chen, K. Panek, C.M. Rembold.
Metformin relaxes rat tail artery by repolarization and resultant decreases in Ca influx and intracelular Ca.
J Hypertens, 15 (1997), pp. 269-274
[25.]
O. Snorgaard, L. Kober, J. Carlsen.
The effect of metformin on blood pressure and metabolism in nondiabetic hypertensive patients.
J Intern Med, 242 (1997), pp. 407-412
[26.]
J.K. Jones, L. Gorkin, J.F. Lian, J.A. Staffa, A.P. Fletcher.
Discontinuation of and changes in treatment after start of new courses of antyhipertensive drugs: a study of a United Kingdom population.
Br Med J, 311 (1995), pp. 293-299
Copyright © 2001. Sociedad Española de Endocrinología y Nutrición
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.