Can Metformin Buffer the Deleterious Association between Psychological Distress and Glycemia in Patients with Type 2 Diabetes?

Wagner J, Keuky L, Horn I, Schumann K, Scully M, Kuoch T. 

Published in the Journal of Endocrinology, Diabetes & Obesity, September 2015.

The full article is available for free at the link below.


Background: Psychological distress is associated with hyperglycemia in persons with diabetes. Preliminary reports suggest that metformin may help buffer the effects of psychological distress on hyperglycemia. Many Cambodians who are currently over age 35 have elevated symptoms of psychological distress from having survived their country's genocide. This study investigated the associations among psychological distress, metformin use, and glucose levels in Cambodians with type 2 diabetes. 

Methods: Patients with type 2 diabetes >1 year, aged 35-80, not using insulin, were recruited from a Cambodian Diabetes Association clinic. Participants provided a fasting finger prick blood sample and completed a psychological assessment. 

Measures: A MiniMed Ultra-II point of care glucometer was used to determine fasting glucose. Participants completed the valid and reliable Khmer language version of the 25-item Hopkins Symptom Checklist (HSCL) which measures symptoms of depression and anxiety. The HSCL was administered via a computerized spoken format which allowed standardized administration and automated data entry. 
Data Analysis: Multiple linear regressions were performed using SPSS v21. 

Results: Participants, n=60, were M=55.7 (SD=9.6) years old, 60% female, 68.3 % were using metformin. Fasting glucose values were above target range, M=143.5 mg/dl (SD=48.1). Mean total scores on the HSCL exceeded the clinical cutoff (1.75) for likely psychiatric disorder, M=1.8 (SD=0.5). In linear regression with main effects in the model there was a significant interaction between psychological distress and metformin use on glucose, (beta=-1.47, t=-2.49, *p<.05). Controlling for age, sex, antidepressant use and other oral hypoglycemic agents did not meaningfully change the findings. Conclusion: Metformin may buffer the deleterious association between psychological distress and glucose. These findings add to a small but provocative literature on the potential metabolic benefits of metformin specifically for patients with psychological distress.


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