Effectiveness And Safety Of Metformin Adjuvant Therapy In Patients With Type 1 Diabetes:a Meta-analysis

Objective: Meta-analysis system was used to compare the efficacy and safety of metformin combined with insulin in patients with Type 1diabetes mellitus(T1DM).Methods: Seven Chinese and English databases,CNKI,Wanfang Database,VIP,Embase,Pubmed,Cochrane Library and Web of Science7,were systematically searched for randomized controlled trials of metformin combined with insulin in the treatment of patients with type 1 diabetes.The retrieval time is from the database establishment to November 2021.According to the inclusion and exclusion criteria of literature,literature was independently screened,data was extracted and methodological quality was evaluated.Meta-analysis was conducted by Revman 5.4 and Stata12.0 software.Results: Totally 20 randomized controlled trials with 1614 patients were included.Metaanalysis showed that compared with insulin alone,metformin adjuvant therapy could reduce the dosage of insulin [SMD=-1.12,95% CI(-1.84,-0.39),P =0.003] and the level of glycosylated hemoglobin [MD=-0.25,95%CI(-0.34,-] 95% CI(-0.79,-0.36),P<0.05] and 2-hour postprandial blood glucose [SMD=-2.81,95% CI(-5.14,-0.47),P =0.02],lowering cholesterol[SMD =-0.90,95] 95% CI(-1.71,-0.39),P =0.002],weight loss [MD=-1.97,95% CI(-2.61,-1.34),P<0.05],BMI[MD=-0.59,95% CI]-1.07),P=0.002],increased the incidence of gastrointestinal reaction [RR= 2.05,95%CI(1.37,3.08),P<0.05],but increased the level of triglyceride [SMD=-0.26,95% CI(-0.26,0.0 P =0.27],the incidence of ketoacidosis [RR =1.51,95 95% CI(0.75,3.05),P =0.25] and the incidence of total adverse reactions [RR = 0.88,95 95% CI(0.72,1.08),P =0.23].Conclusions:Compared with insulin alone,metformin combined with insulin may reduce the dosage of insulin in patients with type 1 diabetes,which is beneficial to blood sugar control and increase the incidence of gastrointestinal reactions.Therefore,medical staff should consider its adverse reactions and strengthen monitoring during the treatment.It is suggested that randomized controlled trials with high quality and large sample size should be carried out in the future to further prove the results.