Effect of metformin treatment on multiple cardiovascular disease risk factors in patients with type 2 diabetes mellitus
Effect of metformin treatment on multiple cardiovascular disease risk factors in patients with type 2 diabetes mellitus
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DOI：
10.1016/j.metabol.2003.07.020
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发表时间：
2004-02-01
影响因子：
9.8
通讯作者：
Reaven, GM
中科院分区：
文献类型：
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作者：
Abbasi, F;Chu, JW;Reaven, GM
鉴于最近英国前瞻性研究（UKPDS）的相互矛盾的结果，其中二甲双胍单药治疗的糖尿病患者全因死亡率较低，而磺脲类药物治疗的患者中添加二甲双胍与糖尿病相关死亡风险增加相关，我们试图比较对心血管疾病（CVD）的影响，二甲双胍单药治疗与二甲双胍联合磺脲类药物治疗2型糖尿病患者的危险因素31名2型糖尿病志愿者，16名接受饮食治疗，15名接受磺脲类药物单药治疗（SU），接受二甲双胍治疗12周。测定空腹血糖、血红蛋白A（1c）、血脂、残脂蛋白胆固醇（RLP-C）、低密度脂蛋白（LDL）颗粒大小，以及一天血糖、胰岛素、游离脂肪酸（FFA）、甘油三酯（TG）、RLP-C浓度;（3）空腹血清可溶性细胞间粘附分子-1（sICAM-1）、可溶性血管细胞粘附分子-1（sVCAM-1）和可溶性E-选择素（sE-选择素）水平。二甲双胍单药治疗组（12.45 +/- 0.48 vs 9.46 +/- 0.47 mmol/L，P <0.001）和SU和二甲双胍联合治疗组（14.09 < 0.51 vs 10.57 < 0.85 mmol/L，P = 0.001）二甲双胍治疗后空腹血糖浓度下降程度相似。两个治疗组的空腹血脂浓度和LDL颗粒大小均无显著变化，而二甲双胍单药治疗组的空腹RLP-C浓度显著降低（0.43 +/- 0.09 vs 0.34 +/- 0.07 mmol/L，P = 0.02）。两个治疗组的全天血糖、FFA、TG和RLP-C浓度降低程度相似，而全天血浆胰岛素浓度无变化。二甲双胍单药治疗组（484 +/- 19 vs 446 +/- 18 ng/mL，P = 0.02）和SU和二甲双胍联合治疗组（496 +/- 29 vs 456 +/- 31 ng/mL，P = 0.05）的空腹血浆sVCAM-1水平均显著降低，而空腹血浆sICAM-1和sE-选择素水平基本不变。二甲双胍单药治疗或与磺酰脲类药物联合治疗可改善2型糖尿病患者的血糖控制，并降低几种CVD风险因素。(C)2004年爱思唯尔公司All rights reserved.
In light of the conflicting results of the recent United Kingdom Prospective Study (UKPDS), where diabetic patients on metformin monotherapy had lower all-cause mortality and the addition of metformin in sulfonylurea-treated patients was associated with an increased risk of diabetes-related death, we sought to compare the effects on cardiovascular disease (CVD) risk factors of metformin monotherapy with metformin treatment when added to a sulfonylurea compound in patients with type 2 diabetes. Thirty-one volunteers with type 2 diabetes mellitus, 16 on dietary therapy and 15 on sulfonylurea monotherapy (SU), were treated with metformin for 12 weeks. Measurements were made of (1) fasting plasma glucose, hemoglobin A(1c) (HbA(1c)), lipid, remnant lipoprotein cholesterol (RLP-C) levels, and low-density lipoprotein (LDL) particle size; (2) daylong plasma glucose, insulin, free fatty acid (FFA), triglyceride (TG), and RLP-C concentrations; and (3) fasting levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble E-selectin (sE-selectin). Fasting plasma glucose concentrations decreased to a similar degree after treatment with metformin in both the metformin monotherapy group (12.45 +/- 0.48 v 9.46 +/- 0.47 mmol/L, P < .001) and the combined SU and metformin therapy group (14.09 < 0.51 v 10.57 < 0.85 mmol/L, P = .001). Fasting plasma lipid concentrations and LDL particle size did not significantly change in either treatment group, whereas fasting RLP-C concentrations were significantly lower in the metformin monotherapy group (0.43 +/- 0.09 v 0.34 +/- 0.07 mmol/L, P = .02). Daylong concentrations of plasma glucose, FFA, TG, and RLP-C were lower to a similar degree in both treatment groups, whereas daylong plasma insulin concentrations were unchanged. Fasting plasma sVCAM-1 levels were significantly lower in both the metformin monotherapy group (484 +/- 19 v 446 +/- 18 ng/mL, P = .02) and the combined SU and metformin therapy group (496 +/- 29 v 456 +/- 31 ng/mL, P = .05), whereas fasting plasma sICAM-1 and sE-selectin levels were essentially unchanged. Administration of metformin, either as monotherapy or in combination with a sulfonylurea drug, improved glycemic control and led to a decrease in several CVD risk factors in patients with type 2 diabetes. (C) 2004 Elsevier Inc. All rights reserved.