EFFECTS OF A COMBINATION THERAPY WITH ATORVASTATIN AND METFORMIN ON THE GLYCEMIC CONTROL AND ADIPOSITY INDICES IN NEWLY DIAGNOSED OVERWEIGHT PATIENTS WITH TYPE 2 DIABETES MELLITUS: A PILOT STUDY

Authors

  • Samer Shukur Mohammed Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq. http://orcid.org/0000-0002-1909-417X
  • Wael Waleed Mustafa Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq. http://orcid.org/0000-0001-6666-1598
  • Saad Abdulrahman Hussain Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq. http://orcid.org/0000-0002-9197-6521

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i12.28309

Keywords:

Metformin, Atorvastatin, Type 2 diabetes mellitus, Adiposity index, Glycemic control

Abstract

Objective: In many type 2 diabetes mellitus (T2DM) patients, metformin is prescribed concomitantly with hypolipidemic agents, particularly statins. Meanwhile, variability in response to metformin is one of the most important problems in the efficacy of this combination. The present study aims to evaluate the effect of adding atorvastatin with metformin on the glycemic control, adiposity indices, and lipid profile of overweight patients newly diagnosed with type T2DM.

Methods: A total of 50 overweight patients with T2DM were allocated into two groups, the first one received 850 mg/day of sustained release metformin and the second group received 10 mg/day atorvastatin in addition to the metformin. The patients were followed for 90 days through evaluating fasting serum glucose (FSG), glycated hemoglobin (HbA1c), body mass index (BMI), visceral adiposity index (VAI), and the lipid profile at baseline and after 90 days. In addition, the safety of the protocol was monitored through the evaluation of the renal and liver functions.

Results: HbA1c, FSG, BMI, and VAI values were significantly decreased in both treatment groups compared with baseline. Meanwhile, the combination improves all the lipid profile components with respect to the baseline. No significant differences reported between the two groups regarding all the measured parameters. The addition of atorvastatin produced a slight but significant negative impact on the renal and liver functions.

Conclusion: Addition of 10 mg/day atorvastatin with metformin in the treatment of newly diagnosed T2DM overweight patients did not produce significant improvement in glycemic control, adiposity index, and lipid profile compared with the use of metformin alone.

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References

Moradi M, Mousavi S. Drug use evaluation of diabetes mellitus in non-hospitalized patients. Int J Pharm Pharm Sci 2016;8:337-41.

Ramanna MK, Ruckmani A, Janti SS, Eerike M, Prabu RL. Burden of therapy in patients suffering from diabetes mellitus and hypertension. Int J Pharm Pharm Sci 2017;9:210-5.

Athyros VG, Kakafika AI, Tziomalos K, Karagiannis A, Mikhailidis DP. Pleiotropic effects of statins: Clinical evidence. Curr Pharm Des 2009;15:479-89.

Okopien B, Krysiak R, Kowalski J, Madej A, Belowski D, Zielinski M, et al. Monocyte release of tumor necrosis factor-alpha and interleukin- 1beta in primary Type IIa and IIb dyslipidemic patients treated with statins or fibrates. J Cardiovasc Pharmacol 2005;46:377-86.

Pruski M, Krysiak R, Okopien B. Pleiotropic action of short-term metformin and fenofibrate treatment, combined with lifestyle intervention, in Type 2 diabetic patients with mixed dyslipidemia. Diabetes Care 2009;32:1421-4.

Bulcao C, Ribeiro-Filho FF, Sanudo A, Ferreira SG. Effects of simvastatin and metformin on inflammation and insulin resistance in individuals with a mild metabolic syndrome. Am J Cardiovasc Drugs 2007;7:219-4.

Buse JB, Tan MH, Prince MJ, Erickson PP. The effects of oral anti-hyperglycemic medications on serum lipid profiles in patients with Type 2 diabetes. Diabetes Obes Metab 2004;6:133-56.

Costa J, Borges M, David C, Carneiro AV. Efficacy of lipid lowering drug treatment for diabetic and nondiabetic patients: A meta-analysis of randomized controlled trials. BMJ 2006;332:1115-24.

Owusu ES, Samanta M, Shaw JE, Majeed A, Khunti K, Paul SK. Weight loss and mortality risk in patients with different adiposity at diagnosis of Type 2 diabetes: A longitudinal cohort study. Nutr Diabetes 2018;8:37.

Crandall JP, Mather K, Rajpathak SN, Goldberg RB, Watson K, Foo S, et al. Statin use and risk of developing diabetes: Results from the diabetes prevention program. BMJ Open Diabetes Res Care 2017;5:e000438.

Macedo AF, Douglas I, Smeeth L, Forbes H, Ebrahim S. Statins and the risk of Type 2 diabetes mellitus: Cohort study using the UK clinical practice search datalink. BMC Cardiovasc Disord 2014;14:85.

Bosi E. Metformin–the gold standard in Type 2 diabetes: What does the evidence tell us? Diabetes Obes Metab 2009;11:3-8.

Mahrooz A, Parsanasab H, Hashemi-Soteh MB, Kashi Z, Bahar A, Alizadeh A, et al. The role of clinical response to metformin in patients newly diagnosed with Type 2 diabetes: A monotherapy study. Clin Exp Med 2015;15:159-65.

Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195-207.

Bennet PH. Impact of the new WHO classification and diagnostic criteria. Diabetes Obes Metab 1999;1 Suppl 2:S1-6.

Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral adiposity index: A reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 2010;33:920-2.

Kooy A, de Jager J, Lehert P, Bets D, Wulffelé MG, Donker AJ, et al. Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with Type 2 diabetes mellitus. Arch Intern Med 2009;169:616-25.

Luo F, Guo Y, Ruan GY, Long JK, Zheng XL, Xia Q, et al. Combined use of metformin and atorvastatin attenuates atherosclerosis in rabbits fed a high-cholesterol diet. Sci Rep 2017;7:2169.

Preiss D, Lloyd SM, Ford I, McMurray JJ, Holman RR, Welsh P, et al. Metformin for non-diabetic patients with coronary heart disease (the CAMERA study): A randomized controlled trial. Lancet Diabetes Endocrinol 2014;2:116-24.

Forouzandeh F, Salazar G, Patrushev N, Xiong S, Hilenski L, Fei B, et al. Metformin beyond diabetes: Pleiotropic benefits of metformin in attenuation of atherosclerosis. J Am Heart Assoc 2014;3:e001202.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.

Cheng D, Wang Y, Gao S, Wang X, Sun W, Bai L, et al. Atorvastatin delays the glucose clearance rate in hypercholesterolemic rabbits. Biomed Pharmacother 2015;72:24-9.

Cederberg H, StanÄáková A, Yaluri N, Modi S, Kuusisto J, Laakso M. Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: A 6-year follow-up study of the METSIM cohort. Diabetologia 2015;58:1109-17.

Wang KL, Liu CJ, Chao TF, Chen SJ, Wu CH, Huang CM, et al. Risk of new-onset diabetes mellitus versus reduction in cardiovascular events with statin therapy. Am J Cardiol 2014;113:631-6.

König J, Seithel A, Gradhand U, Fromm MF. Pharmacogenomics of human OATP transporters. Naunyn Schmiedebergs Arch Pharmacol 2006;372:432-43.

Krysiak R, Okopien B. The effect of metformin on monocyte secretory function in simvastatin-treated patients with impaired fasting glucose. Metabolism 2013;62:39-43.

Björnsson ES. Hepatotoxicity of statins and other lipid-lowering agents. Liver Int 2017;37:173-8.

Nasri H, Hasanpour Z, Nematbakhsh M, Ahmadi A, Rafieian-Kopaei M. The effect of the various doses of atorvastatin on renal tubular cells; an experimental study. J Nephropathol 2016;5:111-5.

Rubenfire M, Brook RD, Rosenson RS. Treating mixed hyperlipidemia and the atherogenic lipid phenotype for prevention of cardiovascular events. Am J Med 2010;123:892-8.

Published

07-12-2018

How to Cite

Mohammed, S. S., W. W. Mustafa, and S. A. Hussain. “EFFECTS OF A COMBINATION THERAPY WITH ATORVASTATIN AND METFORMIN ON THE GLYCEMIC CONTROL AND ADIPOSITY INDICES IN NEWLY DIAGNOSED OVERWEIGHT PATIENTS WITH TYPE 2 DIABETES MELLITUS: A PILOT STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 11, no. 12, Dec. 2018, pp. 209-13, doi:10.22159/ajpcr.2018.v11i12.28309.

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