Metformin May Reduce Heart Risk for Type 1 Diabetics
Metformin may decrease long-term heart disease risk in middle-aged adults with type 1 diabetes and increased risk of cardiovascular disease.
In a new global study, middle-aged adults at a higher risk for cardiovascular disease and with type 1 diabetes may receive additional assistance with metformin treatments. The international trial called REMOVAL enrolled participants from five different countries including, the Netherlands, Australia, Canada, Denmark, and the United Kingdom. Using ultrasound, doctors measured the extent of atherosclerosis in the arteries which are a condition that hardens the arteries and is the precursor to heart disease including strokes, heart attacks, and peripheral vascular disease. The study was published in the journal The Lancet Diabetes & Endocrinology.
22 Year Study Reveals Metformin Health Benefits
The REMOVAL study involved 428 participants who were of middle age with long-term type 1 diabetes. The clinical trial took place over 33 years. All patients had risk factors that increased their likelihood of developing cardiovascular disease including family history, high cholesterol, high blood pressure, smoking, high BMI over 27, A1C over 8, diabetes for over 20 years, and peripheral vascular disease.
Participants were given treatments every 3 years of oral metformin or a placebo. Over the 33 year trial, patients receiving the oral metformin were able to reduce their insulin treatments, had lower cholesterol and also were able to lose weight. The results indicate that reducing weight and cholesterol levels play a role in the improvement of atherosclerosis.
On the downside, Glomerular Filtration Rates were up sharply during the start of metformin and A1C levels were only reduced within the first 3 months of the treatment, but researchers say more studies have to be done before drawing any conclusions. Also, a small percentage of participants had to stop due to abdominal pain or nausea. However, there was no corresponding higher risk of hypoglycemia.
Researchers said that with metformin treatment, weight loss and lower insulin doses were expected, but they were surprised at the data showing patients lowered their LDL cholesterol levels and slowed the progression of their atherosclerosis.
New Guidelines For Patients with T1D
Lead author Professor Petrie said the research confirmed that patients with type one diabetes were only able to improve blood sugar counts for a short period and advised current guidelines for the U.K and U.S. be updated to reflect the research findings.
The study may justify a reduction of metformin prescriptions for blood glucose control in patients with type 1 diabetes. The success of REMOVAL should warrant metformin treatment as a proven method to reduce cardiovascular disease factors for people with type 1 diabetes.
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John R Petrie et al. Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial, The Lancet Diabetes & Endocrinology (2017). DOI: 10.1016/S2213-8587(17)30194-8