A groundbreaking clinical trial in Australia has revealed that metformin, a low-cost medication developed nearly 100 years ago for type 2 diabetes, can significantly reduce the amount of insulin needed by people with type 1 diabetes. This discovery could revolutionize the management of type 1 diabetes, improving quality of life for millions worldwide.
Type 1 diabetes affects roughly 450,000 people in the UK alone and occurs when the immune system destroys insulin-producing cells in the pancreas. Patients must rely on lifelong insulin therapy to regulate their blood glucose levels. However, prolonged insulin use can sometimes lead to insulin resistance, where the body’s cells become less responsive, necessitating ever-higher doses.
While metformin has been used off-label to address insulin resistance in type 1 diabetes based on anecdotal evidence, this is the first randomized controlled trial to rigorously assess its effects. Led by Dr. Jennifer Snaith and Professor Jerry Greenfield at the Garvan Institute of Medical Research, the study enrolled 40 adults with long-standing type 1 diabetes who were assigned to receive either metformin or a placebo over six months.
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Using a sophisticated clamp study method to measure insulin resistance across different tissues, researchers made an unexpected discovery: metformin did not improve insulin sensitivity in type 1 diabetes patients. Instead, it reduced the overall insulin requirement by approximately 12% compared to placebo.
Dr. Snaith emphasized the significance of this result, highlighting that while insulin remains the cornerstone of therapy, it comes with considerable physical and psychological challenges. Lowering insulin doses could ease these burdens for patients.
“This affordable and widely accessible drug may help reduce the dependency on insulin for those managing type 1 diabetes, improving patient outcomes,” Dr. Snaith said.
Professor Greenfield added that metformin’s mechanism in this context remains unclear. “We initially believed metformin would reduce insulin resistance, but our findings indicate otherwise. Our next goal is to unravel how metformin achieves this insulin-sparing effect.”
One promising avenue is metformin’s impact on the gut microbiome. Dr. Snaith noted ongoing investigations into how alterations in gut bacteria might influence the drug’s benefits in type 1 diabetes—a novel area yet to be explored thoroughly.
With this new evidence, metformin may soon become an integral part of type 1 diabetes care, offering hope for better control and fewer insulin-related complications.