LANCET Sub-Journal: Metformin improves the "full moon face" caused by long-term use of hormones

Full moon face features facial obesity, known as a full moon, as a result of a build-up of facial fatAbnormal or excessive pituitary gland siphons secrete to adrenal corticosteroids, adrenal adenomas, cancerous tumors, or cortisol hyperplasia caused by long-term use of glucocorticoid therapyTypical manifestations include: rounded face, edema, double armpits, upper lip protruding, full of collarbone nestCushing syndrome caused by endogenous anerative lesions can be treated with surgical treatment, surgical treatment, and drug therapy that inhibits the secretion of cortisolThe full moon face caused by glucocorticoids should gradually reduce the use of hormones, and generally can subside on their own after discontinuationsome patients have to undergo long-term hormone therapy for disease reasons, and long-term excess corticosteroid exposure can lead to unique torso obesity, high blood pressure, high blood sugar, abnormal blood lipids, high blood clotting, fatty liver, osteoporosis, increased risk of infection and other complicationsa recent phase 2 clinical study published in thethe journal THELANCE DIABETES AND ENDOCRINOLOGYshowed that metformin has the potential to improve associated adverse reactions due to long-term use of hormones while retaining the anti-inflammatory effects of glucocorticoidsThe study analyzed 40 participants who received hormone therapy for a long time, 19 of whom received metformin (850 mg) daily, 21 received placebo therapy, and a total of 12 weeks of drug interventionthis is a randomized, double-blind, placebo-controlled, proof-of-concept Phase 2 clinical trial involving four hospitals in the UKPatients without diabetes, if they are between the ages of 18 and 75, are treated with continuous perisonolone (?20 mg/day, s.4 weeks, and 10 mg/day, or equivalent cumulative dose s.) within the next 12 weeksRandomly assigned eligible patients (1:1) to metformin or placebo groups, based on age and BMI stratificationOral metformin and placebo in incremental doses for 12 weeks: 850 mg / day per day for the first 5 days, 850 mg twice daily for the next 5 days, followed by 3 times a day at 850 mgThe main endpoint was the difference between the group in the area of internal organs and subcutaneous fat during the 12-week CT assessmentSecondary endpoints include changes in metabolic, bone, cardiovascular and inflammatory parameters within 12 weeksstudy found that between July 17, 2012 and January 14, 2014, 849 patients were assessed, of which 53 were randomly assigned to be treated with metformin (n s 26) or placebo (n s 27) for 12 weeksNineteen patients in the metformin group and 21 in the placebo group met the criteria for the analysis of the main resultsBoth groups received a similar cumulative dose of glucocorticoids (metformin was 1860 mg of fenifion equivalent (IQR 1060-2810) while the placebo group was 1770 mg (1020-2356)); p s 0.76)There was no change in the visceral and subcutaneous fat ratio of the two groups (0.11,95% CI -0.02 to 0.24; p - 0.09), but patients in the metformin group had subcutaneous fat compared to the placebo group (-3835 mm2, 95% CI -6781 to -888; p - 0.01)Compared to the placebo group, the metformin group observed improvements in lipid, liver and bone metabolic indicatorsIn addition, the patients in the metformin group had improved fibrin dissolution, mid-layer thickness of the endoscosis of the carotid artery, inflammatory parameters, and clinical indicators of disease activityThe frequency of pneumonia (1 case in metformin group, 7 cases in placebo group; p s 0.01), the overall incidence of moderate to severe infection (2 cases vs 11; p s 0.001) and the number of people hospitalized for adverse events in the whole metformin group (1 to 9; p - 0.001) were lower than in the placebo groupPatients with metformin had more diarrhoeal events (18 cases vs8; p0.01)Although there was no significant difference in the ratio of two groups of visceral-subcutaneous fat, the proportion of "full moon face" in themetformin group was significantly lower than that of the control group, in addition to theof improved breathing difficulties, reduced risk of pneumonia, reduced risk of moderate-severe infection, reduced hospitalization due to adverse events, increased bone density and improvement of a number of metabolic indicatorsThis study suggests that metformin can be used to improve the likelihood of such adverse reactions and provides the basis for further exploration of the combined use of metformin and glucocorticoids