Categorie: Algemeen (geen categorie)
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AuteurBerichten
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13 april 2005 om 14:49 ReactieMisja Sprengers, diabetesverpleegkundige
Is er onderzoek bekend over het gebruik van metformine bij DM type 1 met overgewicht? Zijn er ervaringen mee in Nederland?
18 april 2005 om 09:30 ReactieDiabetes2.nlGeachte collega,
Dit soort vragen zijn goed te beantwoorden door een goede search te doen PubMed. Wij hebben 2 jaar geleden hier ook een boek over geschreven (het effectief zoeken van medische literatuur), maar dit is helaas uitverkocht. In het volgend nummer van DiabeteSpecialist komt een bijlage met een kort uitleg over het zoeken en vinden van literatuur.
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Deze search was relatief eenvoudig omdat er nog weinig kwalitatief goed onderzoek is uitgevoerd. We hebben in PubMed gezocht met de volgende zoekstrategie (wordt nog wel uitgelegd in Diabetespialist):
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(diabetes type 1 OR "Diabetes Mellitus, Type 1"[MeSH] ) AND metformin AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))
Hiermee vonden we 8 artikelen (uit de ruim 15 miljoen medische artikelen). 3 artikelen bleken relevant. Zie hieronder het abstract van de 3 artikelen.
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Zoals te zien is lijkt er wel enig bewijs voor deze behandeling. Het zijn wel kleine studies die kortdurend het effect hebben bekeken. In sommige gevallen waarbij de diabetes niet goed te reguleren is en de patiënt misschien nog wel kenmerken heeft van het metabole syndroom is het op zich wel te proberen. Metformine is een veilig geneesmiddel (mits de contra-indicaties goed bewaakt worden) en het is ook nog een goedkoop.
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Wij hebben hier zelf geen ervaring mee. Ik heb de vraag nog doorgestuurd aan Dr Kooy. Mogelijk dat hij hier ervaring mee heeft of een andere instelling kent waar hier in NL ervaring mee is.
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1: Eur J Endocrinol. 2003 Oct;149(4):323-9.
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Metformin as additional therapy in adolescents with poorly controlled type 1
diabetes: randomised placebo-controlled trial with aspects on insulin
sensitivity.
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Sarnblad S, Kroon M, Aman J.
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Department of Paediatrics, University Hospital, Orebro, Sweden.
stefan.sarnblad@orebroll.se
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OBJECTIVE: Metabolic control often deteriorates during puberty in children with
type 1 diabetes. The aim of the present study was to investigate whether
addition of metformin for 3 Months improves metabolic control and insulin
sensitivity. DESIGN: Twenty-six of 30 randomised adolescents with type 1
diabetes (18 females, eight males) completed a double-blind placebo-controlled
trial. Their mean age was 16.9+/-1.6 (s.d.) Years, mean glycated haemoglobin
(HbA(1c)) 9.5+/-1.1% and daily insulin dosage 1.2+/-0.3 U/kg. The participants
were randomised to receive oral metformin or placebo for 3 Months. HbA(1c) was
measured Monthly, and peripheral insulin sensitivity was assessed by a
euglycaemic hyperinsulinaemic clamp at baseline and at the end of the study.
RESULTS: HbA(1c) decreased significantly in the group treated with metformin,
from 9.6 to 8.7% (P<0.05), but was unchanged in the placebo group (9.5 vs 9.2%).
Peripheral glucose uptake divided by mean plasma insulin concentration was
increased in the metformin group (P<0.05) but not in the placebo group. Initial
insulin sensitivity was inversely correlated to changes in HbA(1c) (r=-0.62;
P<0.05) and positively correlated to changes in insulin sensitivity (r=0.77;
P<0.01). CONCLUSIONS: In this double-blind placebo-controlled study we found
that metformin improves metabolic control in adolescents with type 1 diabetes.
The effect seems to be associated with an increased insulin-induced glucose
uptake.
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2: Diabetes Care. 2003 Jan;26(1):138-43.
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Metformin as an adjunct therapy in adolescents with type 1 diabetes and insulin
resistance: a randomized controlled trial.
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Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D.
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Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada.
jill.hamilton@sickkids.ca
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OBJECTIVE: To evaluate whether, in adolescents with type 1 diabetes, the
addition of metformin to insulin and standard diabetes management results in 1)
higher insulin sensitivity and 2) lower HbA1c, fasting glucose, insulin dosage
(units per kilogram per day) and BMI. RESEARCH DESIGN AND METHODS: This was a
randomized, placebo-controlled 3-month trial of metformin therapy in 27
adolescents with type 1 diabetes, high insulin dosage (>1 unit. kg(-1).
day(-1)), and HbA1c >8%, with measurements of insulin sensitivity (by frequently
sampled intravenous glucose tolerance test [FSIGT]), HbA1c, insulin dosage, and
BMI at the onset and end of treatment. RESULTS: At t = 0, HbA1c was 9.2 +/-
0.9%, insulin dosage was 1.2 +/- 0.2 units. kg(-1). day(-1), fasting glucose was
10.6 +/- 2.4 mmol/l, and BMI was 24.2 +/- 3.9 kg/m2 (means +/- SD), with no
difference between the metformin and placebo groups. At the end of the study,
HbA1c was 0.6% lower in the metformin group than in the placebo group (P <
0.05). This was achieved at lower daily insulin dosages (metformin group -0.14
+/- 0.1 vs. placebo group 0.02 +/- 0.2 units. kg(-1). day(-1); P < 0.05), with
no significant change in BMI. Fasting glucose levels improved significantly in
the metformin group (P < 0.05). Change in insulin sensitivity, measured by
FSIGT, was not significantly different between the two groups at study end. Mild
hypoglycemia occurred more frequently in the metformin-treated than in the
placebo subjects (1.75 +/- 0.8 vs. 0.9 +/- 0.4 events. patient(-1). week(-1); P
= 0.03). There were no differences in frequency of severe hypoglycemic episodes
or gastrointestinal complaints between the two groups. CONCLUSIONS: Metformin
treatment lowered HbA1c and decreased insulin dosage with no weight gain in
teens with type 1 diabetes in poor metabolic control. Changes in insulin
sensitivity were not documented in this study using the FSIGT. Long-term studies
will determine whether these improvements are sustained and whether certain
subgroups accrue greater benefit from this therapy.
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3: Diabetes Care. 2002 Dec;25(12):2153-8.
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The benefits of metformin therapy during continuous subcutaneous insulin infusion
treatment of type 1 diabetic patients.
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Meyer L, Bohme P, Delbachian I, Lehert P, Cugnardey N, Drouin P, Guerci B.
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Service de Diabetologie, Maladies Metaboliques & Maladies de la Nutrition,
CIC-INSERM, Hopital Jeanne d'Arc, Centre Hospitalo-Universitaire de Nancy, Toul,
France.
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OBJECTIVE: This study was designed to assess the insulin-sparing effect of oral
administration of metformin along with a continuous subcutaneous insulin
infusion (CSII) for the treatment of type 1 diabetic patients. RESEARCH DESIGN
AND METHODS: A total of 62 patients (25 women and 37 men) were studied in a
monocenter, randomized, double-blind placebo-controlled study, comparing
metformin (850 mg b.i.d.) with placebo in association with CSII during a 6-month
period. RESULTS: Treatment with metformin was associated with a reduction in
daily insulin requirements between V0 and V6 of -4.3 +/- 9.9 units (-7.8 +/-
18%) compared with an increase with placebo treatment of 1.7 +/- 8.3 units (2.8
+/- 12.7%) (P = 0.0043). A decrease in basal requirement of insulin was also
observed in patients treated with metformin of -2.6 +/- 3.2 units (-7.9 +/-
23.8%) compared with an increase with placebo treatment of 1.9 +/- 5.7 units
(8.8 +/- 27.1%) (P = 0.023). HbA(1c) remained unchanged in treatment with
metformin and placebo between V0 and V6. The number of hypoglycemic events (<60
mg/dl) was similar in both groups. Significant reductions of total cholesterol
(P = 0.04) and LDL cholesterol (P = 0.05) were observed in patients treated with
metformin. Gastrointestinal events, including diarrhea and abdominal pain, were
reported in three patients in the metformin group who discontinued the trial.
Mild or moderate gastrointestinal side effects were also reported in eight
patients treated with metformin and two patients treated with placebo (P =
0.069). CONCLUSIONS: Metformin was found to be a safe insulin-sparing agent,
when used in combination with CSII for the treatment of type 1 diabetes.
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