From Pernicova I et al. Lancet Diabetes Endocrinol 25 Feb 2020
Long-term glucocorticoids, most often prednisolone, are prescribed for about 3% of European adults. The long term exposure can raise metabolic, infectious and cardiovascular risks.
This was a trial of 53 adults who had inflammatory disease treated with prednisolone but did not have diabetes, who were given either 12 weeks of metformin or a placebo.
The dose of prednisolone was 20mg or more for the first month and then 10mg or more for the next 12 weeks. The dose of metformin given was up to 850mg three times a day.
Facial fatness was in seen in 52% of the placebo group but only 10% in the metformin group.
Increased blood sugar was seen in 33% of the placebo group and none of the metformin group.
There was improvement in insulin resistance, beta cell function, liver function, fibrinolysis, carotid intima media thickness, inflammatory parameters and disease activity severity markers in the metformin group.
There were fewer cases of pneumonia, moderate to severe infections and all causes of hospitalisation for adverse events in the metformin group.
What got worse:
Diarrhea was worse in the metformin group.
What didn’t get better:
Visceral to subcutaneous fat ratio was unchanged between the groups.
My comment: Looks like a clear winner for adding metformin to long term prednisolone treatments.