ArticleFrontiers in pharmacology2026
Plasma metformin concentration as a determinant of metabolic response in adults with type 1 diabetes: a 1-year prospective observational study.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Metformin is commonly used as adjunctive therapy in adults with type 1 diabetes (T1DM), although evidence regarding its long-term metabolic effects remains inconsistent. To assess the metabolic effects of adjunctive metformin therapy in adults with type 1 diabetes (T1DM) over a 12-month period, using advanced markers of metabolic control, including time in range (TIR), estimated glucose disposal rate (eGDR), and monitoring of metformin plasma concentrations. Methods: This single-center, observational study included 26 adults with T1DM treated with extended-release metformin (500-2000 mg/day). Metformin plasma concentrations were measured at baseline and at 5 time points up to 12 months using a validated UPLC-MS/MS method. Glycemic control (TIR), insulin dose, anthropometric parameters, lipid profile, visceral adiposity index (VAI), and eGDR were assessed. Participants were grouped by median metformin concentration. Results: Interindividual variability in metformin plasma concentrations was significant. Adjunctive metformin therapy was associated with significant reductions in LDL cholesterol, non-HDL cholesterol, and VAI. A significant transient improvement in eGDR was observed after 6 months of therapy, followed by partial attenuation at 12 months. A significant interaction between metformin concentration subgroup and time was observed for TIR (p = 0.0151), with descriptively greater improvement in participants with higher metformin concentrations. No statistically significant differences in metabolic response were identified between subgroups with lower and higher mean metformin concentrations. Conclusion: Adjunctive metformin therapy in adults with T1DM was associated with favorable changes in insulin sensitivity markers and cardiometabolic risk parameters during follow-up. Monitoring metformin plasma concentrations and eGDR may provide complementary information for metabolic assessment during adjunctive metformin therapy in adults with T1DM.
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