Metformin Improves Peripheral Insulin Sensitivity in Youth with Type 1 Diabetes

Melanie Cree-Green, Bryan C. Bergman, Eda Cengiz, Larry A. Fox, Tamara S. Hannon, Kellee Miller, Brandon Nathan, Laura Pyle, Darcy Kahn, Michael Tansey, Eileen Tichy, Eva Tsalikian, Ingrid Libman, Kristen J. Nadeau

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63 Scopus citations


Context Type 1 diabetes in adolescence is characterized by insulin deficiency and insulin resistance (IR), both thought to increase cardiovascular disease risk. We previously demonstrated that adolescents with type 1 diabetes have adipose, hepatic, and muscle IR, and that metformin lowers daily insulin dose, suggesting improved IR. However, whether metformin improves IR in muscle, hepatic, or adipose tissues in type 1 diabetes was unknown. Objective Measure peripheral, hepatic, and adipose insulin sensitivity before and after metformin or placebo therapy in youth with obesity with type 1 diabetes. Design Double-blind, placebo-controlled clinical trial. Setting Multi-center at eight sites of the T1D Exchange Clinic Network. Participants A subset of 12- to 19-year-olds with type 1 diabetes (inclusion criteria: body mass index ≥85th percentile, HbA1c 7.5% to 9.9%, insulin dosing ≥0.8 U/kg/d) from a larger trial (NCT02045290) were enrolled. Intervention Participants were randomized to 3 months of metformin (N = 19) or placebo (N = 18) and underwent a three-phase hyperinsulinemic euglycemic clamp with glucose and glycerol isotope tracers to assess tissue-specific IR before and after treatment. Main Outcome Measures Peripheral insulin sensitivity, endogenous glucose release, rate of lipolysis. Results Between-group differences in change in insulin sensitivity favored metformin regarding whole-body IR [change in glucose infusion rate 1.3 (0.1, 2.4) mg/kg/min, P = 0.03] and peripheral IR [change in metabolic clearance rate 0.923 (-0.002, 1.867) dL/kg/min, P = 0.05]. Metformin did not impact insulin suppression of endogenous glucose release (P = 0.12). Adipose IR was not assessable with traditional methods in this highly IR population. Conclusions Metformin appears to improve whole-body and peripheral IR in youth who are overweight/obese with type 1 diabetes.

Original languageEnglish (US)
Pages (from-to)3265-3278
Number of pages14
JournalJournal of Clinical Endocrinology and Metabolism
Issue number8
StatePublished - Jun 19 2019

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© 2019 Endocrine Society.


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