Effect of insulin–metformin combination on hepatic steatosis in patients with type 2 diabetes

Lingvay, Ildiko; Raskin, Philip; Szczepaniak, Lidia S.

doi:10.1016/j.jdiacomp.2007.02.005

« Previous Next »Journal of Diabetes and Its Complications
Volume 21, Issue 3 , Pages 137-142, May 2007

Effect of insulin–metformin combination on hepatic steatosis in patients with type 2 diabetes

Ildiko Lingvay
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
- Corresponding author. University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8858, Dallas, TX 75390, USA. Tel.: +1 214 648 2779; fax: +1 214 648 4854.
Philip Raskin
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
Lidia S. Szczepaniak
- Division of Hypertension, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
- Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA

Received 26 January 2007; accepted 11 February 2007.

Abstract

Objective

Hepatic steatosis occurs in up to 78% of patients with type 2 diabetes. Studies evaluating the effect of metformin on hepatic steatosis are conflicting. Insulin is believed to be detrimental due to its lipogenic effect. Since insulin–metformin combination is commonly used for the treatment of diabetes, it is important to assess the effect of this combined therapy on hepatic steatosis. We evaluated the change in hepatic steatosis following the initiation of insulin and metformin in patients with type 2 diabetes.

Methods

Newly diagnosed treatment-naïve patients with type 2 diabetes had their hepatic triglyceride (TG) content measured by magnetic resonance spectroscopy at baseline and after 3 months of treatment with BiAsp 30 insulin, in combination with metformin. Insulin was administered twice daily and titrated to achieve normal capillary blood glucose levels. Metformin was titrated during the first month from 500 mg daily to 1000 mg bid.

Results

The average hepatic TG content in 19 enrolled subjects was 11.83±7.61% (range, 0.93–23.16%) and correlated with body mass index (r=.567). Three months of treatment reduced hepatic steatosis by 45%, with 75% of the study subjects achieving a normal level. The change in hepatic TG content was partially explained by changes in HbA1c (P=.006) and cholesterol (P=.003) levels.