Metformin before and after
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The Role of Metformin Before and After Various Medical Interventions
Metformin Pretreatment in Coronary Artery Bypass Surgery
Metformin and Myocardial Injury Reduction
Research has explored the potential of metformin pretreatment to mitigate myocardial injury during coronary artery bypass graft (CABG) surgery in non-diabetic patients. A double-blind, randomized controlled trial found that short-term metformin pretreatment did not significantly reduce myocardial injury, as measured by plasma troponin concentrations, compared to placebo. Additionally, there were no significant differences in secondary outcomes such as arrhythmias, inotropic support, or intensive care unit stay duration between the metformin and placebo groups. However, gastrointestinal discomfort was more common in the metformin group.
Metformin in Polycystic Ovary Syndrome (PCOS)
Metformin Before and During Ovarian Stimulation
In women with PCOS, metformin has been evaluated for its effects when used before and during controlled ovarian stimulation (COS). A study involving insulin-resistant, non-obese women with PCOS undergoing COS followed by timed intercourse or intrauterine insemination found that metformin pretreatment and co-administration increased the rate of mono-ovulatory cycles. However, it did not significantly impact ovulation, pregnancy, or live birth rates compared to placebo. Another review highlighted that metformin treatment before or during assisted reproductive technology cycles in PCOS women increased clinical pregnancy rates and decreased the risk of ovarian hyperstimulation syndrome, though it did not conclusively improve live birth rates.
Metformin and Gut Microbiome in Type 2 Diabetes
Metformin's Impact on Gut Microbiota
Metformin's therapeutic effects in type 2 diabetes (T2D) may be partly mediated through alterations in the gut microbiome. A study demonstrated that metformin significantly modified the gut microbiota composition in treatment-naive T2D patients, which contributed to improved glucose tolerance. These findings suggest that the gut microbiota plays a role in the antidiabetic effects of metformin.
Metformin Post-Kidney Transplantation
Preventing Post-Transplant Diabetes Mellitus
The Transdiab study is investigating the feasibility, tolerability, and efficacy of metformin in preventing post-transplant diabetes mellitus (PTDM) in kidney transplant recipients with impaired glucose tolerance. This pilot randomized controlled trial aims to provide data that could lead to larger multicenter trials to reduce the incidence or severity of diabetes after kidney transplantation.
Metformin After Gestational Diabetes
Preventing Type 2 Diabetes Post-Pregnancy
The OMAhA study is a randomized, placebo-controlled trial assessing the feasibility of using metformin to prevent type 2 diabetes in postnatal women with a history of gestational diabetes. The primary outcomes include recruitment rates, adherence, and attrition, while secondary outcomes focus on maternal dysglycaemia and quality of life.
Metformin in Pregnancy and Offspring Health
Long-Term Effects on Offspring
Metformin use during pregnancy in women with PCOS has raised concerns about long-term effects on offspring. A follow-up study of children exposed to metformin in utero found that these children had a higher body mass index (BMI) at 5-10 years of age compared to those exposed to placebo, suggesting potential long-term cardiometabolic risks. Another trial in women with type 2 diabetes during pregnancy found that metformin, when added to insulin, improved maternal glycaemic control and reduced maternal weight gain but resulted in a higher proportion of small-for-gestational-age infants.
Metformin for Frailty Prevention in Older Adults
Metformin and Healthy Aging
A clinical trial is examining the potential of metformin to prevent frailty in older adults with pre-diabetes. The study aims to assess whether metformin can improve insulin sensitivity, reduce inflammation, and promote healthy aging, potentially preventing the onset of frailty.
Conclusion
Metformin's role before and after various medical interventions is multifaceted, with potential benefits in specific contexts such as PCOS and type 2 diabetes. However, its efficacy and safety in other scenarios, such as myocardial injury reduction during CABG surgery or long-term effects on offspring when used during pregnancy, require further investigation. Ongoing studies will continue to elucidate the broader implications of metformin use in diverse patient populations.
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