Abstract
BackgroundWe aimed to investigate the long-term effect of metformin on the blood glucose control in non-obese patients with type 2 diabetes mellitus.MethodsA retrospective study was performed in 213 patients with type 2 diabetes mellitus under the administration of metformin for more than one year. The clinical parameters were investigated for 3 years. The obese and non-obese individuals were defined as a body mass index (BMI) of 25 kg/m2 or over (n = 105) and a BMI of less than 25 kg/m2 (n = 108), respectively.ResultsHbA1c levels were significantly decreased compared with those at the baseline time. The course of HbA1c was similar between the non-obese and the obese groups, while the dose of metformin required to control blood glucose was significantly lower in the non-obese group than in the obese group. The reductions in HbA1c were 1.2% and 1.1% at 12 months, 0.9% and 0.9% at 24 months, and 0.8% and 1.0% at 36 months in the non-obese and obese groups, respectively. BMI did not change during the observation periods. Approximately half of all patients required no additional antidiabetic agents or a reduction in other treatments after the initiation of metformin in either of the two groups.ConclusionsThe present study demonstrated the long-term beneficial effect of metformin in non-obese (BMI < 25 kg/m2) diabetic patients. This effect appears to be maintained even after the observation period of this study, because metformin was limited to a relatively low dose in the non-obese group and the observed worsening in glycemic control over time can probably be attenuated by increasing the dose of metformin.
Highlights
We aimed to investigate the longterm effects of metformin on blood glucose control in non-obese Japanese patients with type 2 diabetes mellitus
The dose of metformin required to control the blood glucose levels gradually increased during the observation period (Figure 3), it was significantly lower in the non-obese group (598 ± 132 mg/day at 12 months, 614 ± 138 mg/ day at 24 months and 677 ± 184 mg/day at 36 months) than in the obese group (678 ± 169 mg/day at 12 months, 696 ± 170 mg/day at 24 months and 724 ± 117 mg/day at 36 months)
Clarke and Campbell reported that metformin monotherapy (n = 98) was effective as chlorpropamide (n = 91), one of the sulfonylurea agents, on blood glucose control without HbA1c measurements, and that metformin was superior in the body weight control in non-obese patients with type 2 diabetes mellitus according to a prospective study for 1 year [8]
Summary
We aimed to investigate the long-term effect of metformin on the blood glucose control in non-obese patients with type 2 diabetes mellitus. The UK Prospective Diabetes Study (UKPDS) demonstrated that metformin is as effective as sulfonylurea to control the blood glucose levels of obese patients with type 2 diabetes mellitus. The BMI is 3 - 4 units lower in the general population in Asian compared to Caucasians [4]. It is similar in Japanese diabetic patients, for example, the mean BMI was 22.9 kg/m2 in men and 23.4 kg/m2 in women in the Japan Diabetes Complications Study (JDCS), which was a nationwide multi-center prospective study of type 2 diabetic patients [5]. The strategy for treating non-obese patients is considered to be important in the treatment of type 2 diabetes mellitus for Asians, including Japanese
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