Could Metformin Protect Against CVD in Patients with Type 1 Diabetes?

Metformin may help to slow heart disease development in patients with type 1 diabetes by improving the levels of circulating endothelial progenitor cells (cEPCs), pro-angiogenic cells (PACs), colony forming units (CFU-Hill’s colonies), circulating endothelial cells (cECs), and PACs adhesion while maintaining glycemic control, according to new research.

Cardiovascular disease is common in patients with type 1 diabetes, and patients with type 1 diabetes without cardiovascular disease have been shown to have features of endothelial dysfunction, which has been shown to play a role in the development of cardiovascular disease.
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“There is a need to explore newer treatment options to improve endothelial dysfunction and reduce [cardiovascular disease] risk,” the researchers wrote.

For their study, the researchers sought to test whether metformin could help regulate endothelial circulation, limiting cardiovascular damage in these patients.

Over an 8-week period, the researchers assigned 23 patients who had type 1 diabetes and did not have CVD to a dose of metformin that they could tolerate. The participants were matched with 9 patients on standard treatment for type 1 diabetes and 23 age- and sex-matched healthy controls.

Glycemic control was maintained by adjusting insulin dose, and cEPCs and cECs levels were measured by flow cytometry. The researchers also cultured peripheral blood mononuclear cells to assess changes in PACs, function, and CFU-Hill’s colonies.

At baseline, the participants receiving metformin treatment had lower levels of cEPCs, PACs, CFU-Hill’s colonies, and PACs adhesion and higher levels of cECs than the control group.

After the treatment period, the researchers found that metformin improved levels of cEPCs, PACs, CFU-Hill’s colonies, cECs, and PACs adhesion to levels seen in the control group. HbA1C levels and glucose variability remained unchanged.

In addition, the researchers found an inverse correlation between CFU-Hill’s colonies with cECs.

“In summary, our study has shown for the first time that metformin treatment may result in cardiovascular benefit by increasing markers of vascular repair or health (cEPCs, CFU-Hill's colonies, and PACs) and reducing markers of vascular damage (cECs),” the researchers concluded.  

“This finding needs to be confirmed by long term cardiovascular outcome studies in type 1 diabetes.”

—Amanda Balbi

Reference:

Ahmed FW, Rider R, Glanville M, Narayanan K, Razvi S, Weaver JU. Metformin improves circulating endothelial cells and endothelial progenitor cells in type 1 diabetes: MERIT study [published online August 26, 2016]. Cardiovasc Diabetol. doi:10.1186/s12933-016-0413-6.