Effects of Premeal Versus Postmeal Metformin Administration on Postmeal Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Randomized, 8-Week Crossover Study
Abstract
Aims: To evaluate the effects of premeal versus postmeal metformin administration on postmeal glycemic control in individuals with type 2 diabetes mellitus receiving metformin monotherapy.
Methods: All participants were randomly assigned to receive immediate-release metformin either 30-60 min before or immediately after meal for 4 weeks, and crossed over to the alternate regimen for another 4 weeks. Standardized mixed-meal tests with glucose and insulin measurements were performed, and fructosamine was measured at baseline and at the end of each intervention. Continuous glucose monitoring (CGM) was applied to all during the last week of each intervention. Data were expressed as mean ± SD or estimated mean [95% CI] and were analysed using multilevel mixed-effects linear regression. The primary objective was to compare postmeal glucose responses to a standardized mixed-meal between groups. Secondary objectives were to assess CGM-derived postmeal glucose, fructosamine and insulin responses to a standardized mixed-meal.
Results: Twenty-two women (age 49.5 ± 9.7 years, BMI 29.1 ± 5.0 kg/m2, HbA1c 7.0% ± 0.3%) were enrolled and only 20 were analysed. Glucose incremental area under curve (iAUC, mg/dL.h) after a standardized mixed-meal was significantly lower in the premeal group at 0-1 h (31.4[23.8-38.9] vs. 38.3[30.8-45.9]; p = 0.034) and 0-2 h (79.1[57.9-100.3] vs. 96.3[75.1-117.5]; p = 0.035). CGM showed significantly lower glucose iAUC at 0-1 h (17.4[13.5-21.3] vs.…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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