Corticosteroids (more commonly known as just steroids) are widely used around the world to treat a range of inflammatory and immune diseases, especially asthma. In fact, it’s estimated that some 3% of the general adult population is on long-term steroid treatment for chronic inflammatory disease. For people over 80, it’s at least one in ten. Steroids work by lessening inflammation and also by lowering the activity of the immune system when the immune system malfunctions and starts to cause damage to the body. But, like many useful medications, they can have unwelcome side effects. With steroids they include such things as weight gain, mood changes, acne, blurred vision, osteoporosis, high sugar levels, sleep problems, muscle weakness, increased risk of infection and more.
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A new study from Queen Mary University of London (England) and published in the journal The Lancet Diabetes & Endocrinology now indicates that the drug metformin, which is widely used in the treatment of diabetes because it reduces the amount of sugar the liver releases into the blood and improves the body’s response to insulin, could help lower the side effects of steroids.
Previous research from Marta Korbonits, MD, professor of endocrinology at the London School of Medicine and Dentistry at Queen Mary, had found that steroids can influence a key metabolic protein, called AMP-kinase or AMPK. Also, other studies have indicated that metformin partly acts through this protein. Because of these findings, the researchers thought it advisable to investigate whether metformin could possibly help reverse the side effects of steroids.
The researchers studied 53 patients who did not have diabetes but who were taking high doses of glucocorticoids, a type of steroid used to treat chronic inflammatory disease. During the 12-week trial period, about half of the subjects were given metformin and the other half were given a placebo (an inactive treatment).
The researchers found that the subjects treated with metformin had what the researchers described as “improved clinical outcomes.” For example, in comparison to the group taking a placebo, the metformin patients had lower hospital admissions, as well as a 30% reduction in the rate of infections. In addition, the researchers determined that being treated with metformin not only reinforced the anti-inflammatory effects of the steroids but also benefited several cardiovascular, metabolic and bone markers.
According to Dr. Korbonits, “Our findings are strikingly positive and suggest that a simple and immediately available intervention, treatment with the diabetes drug metformin, can improve the clinical status of patients on glucocorticoid treatment, even if they do not have diabetes. The results could have a huge impact on the large number of patients on long-term glucocorticoids, improving treatment-related complications and their cardiovascular prognosis.” And she went on to say, “Whilst developed countries may be increasing the use of biologics or other steroid-sparing agents, in many other parts of the world there’s still a heavy reliance on glucocorticoids. Therefore, doctors and patients have been waiting for a safe, cheap and effective treatment that can prevent the major metabolic complications of these medicines, but does not affect, or could even improve, their anti-inflammatory properties. Our results suggest metformin has the potential to help these patients.”
As with similar encouraging studies, this one has drawbacks. According to diabetes educator Amy Campbell, MS, RD, CDCES, “This is certainly a promising study as the use of steroids can lead to serious side effects, including high blood glucose levels. However, this was a small study of just 53 patients and, while these patients had chronic inflammatory diseases, they did not have diabetes. The use of steroids, such as prednisone, can reduce the effectiveness of metformin and other diabetes medications, leading to high blood glucose levels. So it’s unclear if people with diabetes would experience similar benefits as the patients in the study.”
Nevertheless, if further studies confirm these findings, it might be that someday metformin won’t be just for diabetes anymore.