STUDY OF METFORMIN’S EFFECTIVENESS IN PREVENTING GLUCOCORTICOIDS-INDUCED HYPERGLYCEMIA IN HEMATOLOGICAL DISEASES

Maram Mohammad*, Arige Boubou and Firas Hussien

ABSTRACT

Introduction: Glucocorticoids are the most common cause of drug-induced hyperglycemia, but there is no international consensus on screening for the incidence of hyperglycemia following the treatment. In vitro studies have shown that glucocorticoids modulate the activity of AMP-activated protein kinase (AMPK), one of the enzymatic mediators of metformin, in different tissues in a tissue-specific manner, while metformin reverses these effects in adipose tissue. Objective: To study the effectiveness of metformin in preventing hyperglycemia following the use of glucocorticoids in the treatment of hematological diseases. Methods: A randomized controlled trial (RCT). The study included 37 patients; who visited Tishreen University Hospital during the period between 2023-2024 and candidates for starting treatment with glucocorticoids for hematological indications. They were randomly divided into two groups. The control group: (18 patients): received glucocorticoids without metformin. The second group: (19 patients): metformin was added with glucocorticoids (metformin group) (we did not find any statistically significant differences between the two groups). Results: The incidence of Glucocorticoids-induced hyperglycemia in the control group was: 55.6% using fasting plasma glucose (FPG) and 77.8% using the 2-h post-prandial glucose (PPG). In the other hand, it was in the metformin group: 10.5% using the (FPG) and 15.8% using the (PPG) We found a very significant statistical difference between the two groups (P = 0.001, P = 0.0001). Conclusions: The addition of metformin at the start of glucocorticoid therapy reduced the incidence of hyperglycemia from 55.6% (FPG) and 77.8% (PPG) to 10.5% (FPG) and 15.8% (PPG).

Keywords: Hyperglycemia, Metformin, Glucocorticoids, Activated protein kinase monophosphate, AMPK.