Acidose lactique et metformine

Evaluation of Antidiabetic Properties of the Leaves Extract of Ficus vallis-choudae Delile in a Model of Type 2 Diabetes Induced by High-Fat Diet and Streptozotocin

This work aimed to determine the phytochemical composition of the aqueous extract of leaves of Ficus vallis-choudae (AEFV) and to evaluate its antidiabetic properties on a model of type 2 diabetes induced by a high-fat diet (HFD) and a low dose of streptozotocin (STZ). The phytochemical analysis was carried out according to several methods using the standard of each bioactive compound. Type 2 diabetes was induced by feeding rats for 4 weeks with HFD lard followed by injection of a low dose of STZ (35 mg/kg). After induction, the rats were divided into groups and treated for 28 days with metformin (40 mg/kg) and the AEFV at doses of 110, 220, and 440 mg/kg. The results showed that the AEFV contains saponins, flavonoids, tannins, and total polyphenols. In addition, it dramatically reduced body mass, body mass index (BMI), atherogenic index (AI), coronary heart risk index (CRI), and abdominal fat and increased homeostatic model assessment of β-cell function (HOMA-β), high-density lipoprotein cholesterol (HDL-c) levels, and cardioprotective index (CI). The AEFV also lowered blood glucose levels, insulinemia, homeostatic model assessment of insulin resistance (HOMA-IR) index, and total cholesterol (TC), triglycerides (TG), low-density lipoproteins cholesterol (LDL-c), and very-low-density lipoproteins cholesterol (VLDL-c) levels. There was a decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity and in urea and serum creatinine levels following the administration of AEFV. The AEFV caused increased superoxide dismutase (SOD) and catalase (CAT) activities, reduced glutathione (GSH) levels, and decreased malondialdehyde (MDA) levels in the liver, kidneys, and heart of rats. The AEFV has hypoglycemic, antioxidant, and cardioprotective properties, thus validating its use in traditional medicine for the treatment of type 2 diabetes and its complications.

Metformin-associated lactic acidosis and acute kidney injury in the era of COVID-19

COVID-19, provoked by SARS-CoV-2, constitutes a global health issue with high rates of mortality. The presence of diabetes mellitus is associated with severe coronavirus COVID-19 as it is related to increased death rates in patients admitted to the intensive care unit. Acute kidney injury is a frequent complication among patients hospitalized for COVID-19 and is met with high morbidity and mortality. Here, we present a case of a diabetic patient with acute kidney injury, metformin-associated lactic acidosis, and COVID-19. Lactic acidosis is a relatively rare but noteworthy complication of metformin use. However, the combination of those life-threatening situations could prove fatal for the patients despite optimal medical care.

Metformin-Induced Lactic Acidosis: A Question of Time

Metformin is an oral antidiabetic largely prescribed in the treatment of type II diabetes. Overdose is associated with life-threatening lactic acidosis. We report the case of the highest metformin concentration ever described secondary to a voluntary suicidal intake. The patient developed a severe lactic acidosis and hemodynamic shock successfully treated with high-flow hemofiltration. Time to start extrarenal epuration is capital to avoid poor evolution.

Metformin for treatment of antipsychotic-induced weight gain: a randomized, placebo-controlled study

OBJECTIVES

To evaluate the efficacy of metformin for treatment of antipsychotic-induced weight gain.

METHODS

Seventy-two patients with first-episode schizophrenia who gained more than 7% of their predrug weight were randomly assigned to receive 1000 mg/d of metformin or placebo in addition to their ongoing treatment for 12 weeks using a double-blind study design. The primary outcome was change in body weight. The secondary outcomes included changes in body mass index, fasting glucose and insulin, and insulin resistance index.

RESULTS

Of the 72 patients who were randomly assigned, 66 (91.6%) completed treatments. The body weight, body mass index, fasting insulin and insulin resistance index decreased significantly in the metformin group, but increased in the placebo group during the 12-week follow-up period. Significantly more patients in the metformin group lost their baseline weight by more than 7%, which was the cutoff for clinically meaningful weight loss. Metformin was tolerated well by majority patients.

CONCLUSION

Metformin was effective and safe in attenuating antipsychotic-induced weight gain and insulin resistance in first-episode schizophrenia patients. Patients displayed good adherence to metformin.

Chronic kidney disease in type 2 diabetes patients in France: prevalence, influence of glycaemic control and implications for the pharmacological management of diabetes

AIM

Type 2 diabetes mellitus (T2DM) is often associated with chronic kidney disease. For this reason, this article reviews the relationship between treatment of T2DM and renal disease.

METHOD

The review presents the recent French data on the management of diabetes in patients with renal impairment, and discusses the implications of renal disease for the treatment of such patients. Prescribing data are presented for various antidiabetic treatments, and the use of the more commonly prescribed medications is discussed with reference to T2DM patients with renal disease.

RESULTS

In France, it is estimated that 4-5% of the general population has T2DM and that almost 40% of patients with end-stage renal failure have diabetes. Diabetes and renal disease are both risk factors for cardiovascular morbidity and mortality. Glycaemic control is pivotal in T2DM patients for minimizing the risk of vascular complications and hypoglycaemic episodes, particularly in patients with renal disease who also have a higher risk of hypoglycaemia. Whereas poorly controlled glycaemia increases the risk of renal disease and its progression, the risk is diminished in patients treated intensively for diabetes and in those who achieve stable glycaemic control. Intensive multitargeted treatment can also help to decrease cardiovascular morbidity and mortality, especially if started early in patients who have not yet developed macrovascular complications.

CONCLUSION

In recent years, considerable improvement has been observed in France regarding the follow-up of diabetic patients. Less extensive, but nonetheless significant, improvement has also been observed in glycaemic control. However, even though treatment decisions generally take renal function into account, some at-risk treatments are often still being used in patients with renal insufficiency.