30DEC

Libyan International Conference for Health Sciences

The First Libyan International Conference for Health Sciences (2024): Open University, Tripoli, Libya
Mediterranean Journal of Pharmacy and Pharmaceutical Sciences
https://ppj.org.ly/article/doi/10.5281/zenodo.13256137

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Short communication

Metformin dosage and renal protection in type 2 diabetes mellitus: impact on estimated glomerular filtration rate

Ghada M. Hadiia, Hamida Albarasi, Sana Abdalrahman, Hamza M. Alasbily, Hayam A. Elawamy, Aisha M. Alfituri, Suhir Gaber, Mona A. Netfa

Downloads: 3
Views: 285

Abstract

Metformin is considered the first-line treatment as a monotherapy for patients with type 2 diabetes mellitus. Emerging evidence suggests that metformin may have a renoprotective role; therefore, understanding the impact of metformin dose and therapy duration on renal function may significantly improve renal outcomes in type 2 diabetes patients. This study aims to investigate the renoprotective effects of metformin by analyzing its dose-dependent impacts on the estimated glomerular filtration rate in patients with type 2 diabetes mellitus. A retrospective cross-sectional study design was used from September 2022 to October 2023. Data from 302 type 2 diabetes patients were collected from patient files at the Benghazi Diabetic Center and the Aljabal Al-Alkdar Diabetic Center, including all with type 2 diabetes mellitus patients on varying doses of metformin. The collected data included age, gender, metformin dose, duration of metformin therapy, urea, and creatinine. Exclusion criteria included patients with significant comorbidities such as chronic kidney disease (other than diabetic nephropathy), liver disease, heart failure, or malignancy; those taking nephrotoxic medications; individuals with recent acute illnesses or surgical procedures; pregnant or lactating women; participants with inadequate medical records; and patients who were non-adherent to metformin therapy. Survival analysis was conducted to evaluate the effect of different metformin doses on the estimated glomerular filtration rate. The study analyzed 302 diabetic patients, of whom 46.0% were male and 54.0% were female. The age was 58.3±11.9 years. The HbA1c was 7.7%±1.3%. The duration of diabetes was 11.4±8.1 years. The creatinine was 1.0±0.9 mg/dL, and the urea was 36.7±23.8 mg/dL. Data analysis revealed a statistically significant difference in survival distribution across the dose groups. Different metformin doses significantly impact the estimated glomerular filtration rate, suggesting that dosage plays a crucial role in maintaining renal function.

Keywords

Cross-sectional study, Libyan population, metformin, renal function, type 2 DM

References

  1. Bailey CJ (2017) Metformin: historical overview. Diabetologia. 60 (9): 1566-1576.  doi: 10.1007/s00125-017-4318-z
  2. Rossetti L, Smith D, Shulman GI, Papachristou D, DeFronzo RA (1987) Correction of hyperglycemia with phlorizin normalizes tissue sensitivity to insulin in diabetic rats. The Journal of Clinical Investigation. 79 (5): 1510-1515. doi: 10.1172/JCI112981
  3. Inzucchi SE, Maggs DG, Spollett GR, Page SL, Rife FS, Walton V, Shulman GI (1998) Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. The New England Journal of Medicine. 338 (13): 867-872. doi: 10.1056/NEJM199803263381303
  4. LaMoia TE, Shulman GI (2021) Cellular and molecular mechanisms of metformin action. Endocrine Reviews. 42 (1): 77-96. doi: 10.1210/endrev/bnaa023
  5. Gonzalez-Lopez C, Wojeck BS (2023) Role of metformin in the management of type 2 diabetes: recent advances. Polish Archives of Internal Medicine. 133 (6): 16511. doi: 10.20452/pamw.16511
  6. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR (2015) Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 38 (1): 140-149. doi: 10.2337/dc14-2441
  7. Hsu WH, Hsiao PJ, Lin PC, Chen SC, Lee MY, Shin SJ (2017) Effect of metformin on kidney function in patients with type 2 diabetes mellitus and moderate chronic kidney disease. Oncotarget. 9 (4): 5416-5423. doi: 10.18632/ oncotarget.23387
  8. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK (2014) Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 312 (24): 2668-2675. doi: 10.1001/jama.2014.15298
  9. de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G (2022) Diabetes management in chronic kidney disease: A consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 45 (12): 3075-3090. doi: 10.2337/ dci22-0027
  10. Wu M, Han W, Song S, Du Y, Liu C, Chen N, Wu H, Shi Y, Duan H (2018) NLRP3 deficiency ameliorates renal inflammation and fibrosis in diabetic mice. Molecular and Cellular Endocrinology. 478: 115-125. doi: 10.1016/ j.mce.2018.08.002
  11. Zhang B, Zhang X, Zhang C, Sun G, Sun X (2021) Berberine improves the protective effects of metformin on diabetic nephropathy in db/db Mice through Trib1-dependent inhibiting inflammation. Pharmaceutical Research. 38 (11): 1807-1820. doi: 10.1007/s11095-021-03104-x
  12. Vieira IH, Barros LM, Baptista FC, Rodrigues DM, Paiva IM (2022) Recommendations for practical use of metformin, a central pharmacological therapy in type 2 diabetes. Clinical Diabetes. 40 (1): 97-107. doi: 10.2337/ cd21-0043
  13. Kwon S, Kim YC, Park JY, Lee J, An JN, Kim CT, Oh S, Park S, Kim DK, Oh YK, Kim YS, Lim CS, Lee JP (2020) The long-term effects of metformin on patients with type 2 diabetic kidney disease. Diabetes Care. 43 (5): 948-955. doi: 10.2337/dc19-0936
  14.  Hung AM, Hackstadt AJ, Griffin MR, Grijalva CG, Greevy RA Jr, Roumie CL (2023) Comparative effectiveness of metformin versus sulfonylureas on kidney function decline or death among patients with reduced kidney function: a retrospective cohort study. CMAJ Open. 11 (1). doi: 10.9778/cmajo.20210207
  15. Boddepalli CS, Gutlapalli SD, Lavu VK, Abdelwahab Mohamed Abdelwahab R, Huang R, Potla S, Bhalla S, AlQabandi Y, Nandula SA, Khan S (2022) The effectiveness and safety of metformin compared to sulfonylureas in diabetic nephropathy: a systematic review. Cureus. 14 (12). doi: 10.7759/cureus.32286

Submitted date:
07/18/2024

Reviewed date:
08/04/2024

Accepted date:
08/07/2024

Publication date:
08/07/2024

66b3a99da953951c70006657 medjpps Articles
Links & Downloads

Mediterr J Pharm Pharm Sci

Share this page
Page Sections