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Low‐dose metformin improves hyperglycaemia related to myotonic dystrophy
Author(s) -
Kouki T.,
Takasu N.,
Nakachi A.,
Tamanaha T.,
Komiya I.,
Tawata M.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01432.x
Subject(s) - medicine , metformin , glimepiride , insulin resistance , myotonic dystrophy , hyperinsulinemia , endocrinology , diabetes mellitus , insulin
Background One of the clinical features of myotonic dystrophy is insulin resistance with non‐obese diabetes mellitus (DM). Recently, the mechanism of insulin resistance in patients with myotonic dystrophy was revealed. The optimal treatment of DM with myotonic dystrophy has not been established. We report the effect of metformin in a patient with myotonic dystrophy without obesity. Case report A 58‐year‐old woman (BMI = 22.1 kg/m 2 ) with myotonic dystrophy and DM was followed at our clinic. She had been treated with glimepiride for DM for the last 6 months, without achieving good control (HbA 1c 9.3%). She was admitted with congestive heart failure and cholecystitis. She was treated with diuretics, antibiotics and insulin. As her blood glucose fell, we discontinued insulin and started glimepiride, but her glycaemic control had worsened. We started metformin instead of glimepiride. After 4 weeks of metformin, HbA 1c was decreased to 7.4%, while HOMA‐IR during glimepiride treatment was 4.9, and 3.7 with metformin. Three months later, HbA 1c was maintained (7.5%). Conclusion It is important to choose the optimal treatment for DM in myotonic dystrophy, because the patients have hyperinsulinemia caused by specific mechanism and could not reduce the insulin resistance. Metformin improved hyperglycemia through increased insulin‐independent glucose uptake in peripheral muscle. We believe metformin is the optimal agent for these patients.