Diabetic peripheral neuropathy (DPN) affects around 50% of the 500 million people with type 2 diabetes worldwide and is considered disabling and irreversible. The present study was undertaken to assess the effect of metformin on peripheral neuropathy outcomes in type 2 diabetes. 69 type 2 diabetes participants receiving metformin were recruited and underwent clinical assessment, peripheral nerve ultrasound, nerve conduction studies and axonal excitability studies. 318 participants who were not on metformin were also concurrently screened, and 69 were selected as disease controls and matched to the metformin participants for age, sex, diabetes duration, BMI, HbA1c and use of other diabetes therapies. Medical record data over the previous 20 years were analysed for previous metformin use. Mean tibial nerve cross-sectional area (CSA) was lower in the metformin group (metformin 14.1 ∓ 0.7 mm2, non-metformin 16.2 ∓ 0.9mm2, p=0.038), accompanied by reduction in neuropathy symptom severity (p=0.021). Axonal excitability studies demonstrated superior axonal function in the metformin group and mathematical modelling demonstrated that these improvements were mediated by changes in nodal Na+ and K+ conductances. Metformin treatment is associated with superior nerve structure, clinical and neurophysiological measures. Treatment with metformin may be neuroprotective in DPN.

中文翻译：

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二甲双胍对 2 型糖尿病周围神经形态的影响：一项横断面观察研究


糖尿病周围神经病变 （DPN） 影响了全球 5 亿 2 型糖尿病患者中的约 50%，并且被认为是致残和不可逆的。本研究旨在评估二甲双胍对 2 型糖尿病周围神经病变结果的影响。招募了 69 名接受二甲双胍治疗的 2 型糖尿病参与者，并接受了临床评估、周围神经超声、神经传导研究和轴突兴奋性研究。还同时筛选了 318 名未服用二甲双胍的参与者，其中 69 名被选为疾病对照，并与二甲双胍参与者的年龄、性别、糖尿病持续时间、BMI、HbA1c 和其他糖尿病疗法的使用相匹配。分析了过去 20 年的病历数据，以确定以前使用过二甲双胍的情况。二甲双胍组的平均胫神经横截面积 （CSA） 较低 （二甲双胍 14.1 ∓ 0.7 mm2，非二甲双胍 16.2 ∓ 0.9 mm2，p = 0.038），伴有神经病变症状严重程度降低 （p = 0.021）。轴突兴奋性研究表明二甲双胍组的轴突功能优越，数学模型表明这些改善是由淋巴结 Na + 和 K+ 电导的变化介导的。二甲双胍治疗与上神经结构、临床和神经生理学指标有关。二甲双胍治疗可能对 DPN 具有神经保护作用。