effect metformin treatment in type 2 DM on some biochemical and clinical manifestations

Metformin is a key treatment option in type 2 diabetes. It was reported to decrease serum vitamin B[12] and folic acid, and may thereby increase the serum total homocysteine level, a cardiovascular risk factor. We investigated the effect of metformin treatment among a group of Type 2 Dabetes Mellitus patients on the serum total homocysteine level, vitamin B[12], folic acid, Calcium, vitamin E, vitamin C, and serum lipids. The associated cardiovascular, neurological, retinal complications were also studied. Patients were taken from the out-patients and in-patients of Ain Shams university hospital. They were all type 2 DM for around 10 years duration. Patients were classified into 2 experimental groups, group [1] included 25 patents, 10 males and 15 females receiving metformin for at lest 6 continuous months, group [2] included 25 patients, 10 males and 15 females receiving insulin for at least 6 continued months. Both group were matched for age, sex, social level. 10 normal persons were taken as control group. A comparative- retrospective study, where comparison between metformin receiving type 2 DM patients were compared with insulin treated patients and a healthy control group for biochemical variables and clinical status. The mean serum total homocysteine level was significantly higher in the metformin group compared to the insulin group [p=0.03] and control group [p=0.000], Vitamin B12 was significantly decreased in metformin group compared to insulin group [p=0.05] and to control group [p=0.001], folic acid was significantly lower in metformin group compared to insulin group [p=0.014] but not significantly changed compared to control group. Total lipids were significantly higher in metformin group compared to insulin group [p=0.001] and to control group [p=0.047]. Vitamin E was significantly lower in metformin group compared to control group [p=0.014] but not to insulin group. Vitamin C was also lower in both Diabetic groups compared to control group. As for the clinical findings, the metformin receiving patients compared to the insulin treated group had higher incidence of cardiovascular complications [68%] versus [60%], peripheral neuritis [91%] versus [85%], retinal complications [38%] versus [26%] and amputation [6%] versus [3%].Metformin is a key drug used all over the word and has an important role in treating type 2 DM. Our results points to an associated increase in homocyteine level among metformin treated type 2 DM compared to insulin treated patients, as a result to decreased serum vitamin B[12] and relative decrease in serum folic acid. A decrease in serum vitamin C and E was also recorded This was reflected on the clinical picture of the patients in the form of increased incidence of cardiovascular complications, peripheral neuritis, retinal complications and amputation. Therefore we recommend vitamin B[12] and folic acid supplementation, in addition to vitamin E and vitamin C supplementation. Stressing the major importance of a diet rich in fresh vegetables and fruits, as a natural source of vitamins and antioxidants This applies for diabetic patients in general and for those receiving metformin in particular

Homocysteine and some related micronutrients status in polycystic ovary patients treated with metformin

Polycystic ovary syndrome [PCOS] is characterized by anovulation, infertility and hyper and rogenism. The condition affects about 5-10% of women in the reproductive age group. Metformin, a well known drug used in the treatment in type 2 diabetes, has been proved to be effective in the management of anovulation and hirsutism and is now a widely accepted therapy for PCOS. Metformin is known to reduce vitamin B12 absorption, decrease serum folic acid inducing elevation in serum homocysteine. Homocysteine is a major risk factor for cardiovascular complications and, thrombosis. Pre-eclampcia is associated with hyperhomocysteinemia and disturbed blood levels of zinc and copper. Neural tube defect has been closely related to maternal folic acid deficiency. In addition, maternal zinc deficiency is recorded to affect fetus brain development. Other maternal and fetal complications may develop as a result to the induced hyper-homocysteinemia, low folic acid and vitamin B12 and other related micronutrients disturbance. The aim of this study is to evaluate the serum level of homocysteine, vitamin B12, folic acid and some related micronutrients in polycystic ovary syndrome [PCOS] patients receiving metformin for a year. This is a retrospective comparative study. 60 patients were included in this study divided into 2 main groups: Group [1] included 40 patients with confirmed diagnoses of PCOS receiving metformin tablets 850 mg three times daily for a year. Group [2] included 20 patients confirmed to have PCOS not receiving metformin. Patients were selected from the outpatient gynecology clinic of Ain Shams University Hospital. Serum homocysteine was significantly increased in patients receiving metformin compared to those not receiving metformin, [p=0.001]. Folic acid and calcium showed relative decrease in patients receiving metformin [p> 0.05]. Vitamin B12, zinc, calcium and magnesium serum levels showed significant decreases, [p=0.001, 0.045, 0.001 and 0.001 respectively]. Phosphorus showed raise in serum level among the group receiving metformin [p=0.003]. Metformin although proved to have positive effect in reducing body hair and help to regulate the menstrual cycle increasing the possibility for pregnancy. Our study recorded increase in serum homocysteine, decrease in vitamin B12, folic acid, zinc, magnesium, calcium and copper. Multiple health hazards are facing those patients and their expected babies. Supplementation and enhancing diet rich in Vitamin B12, folic acid, calcium, zinc and magnesium is highly recommended. A diet restricted in caloric intake to help weight loss and rich in vegetables, fruits, milk and meat is recommended. Close medical assessment and follow up is m and atory to guard against possible risk hazard both for mother and fetus