The effect of Metformin and its combinations with other hypoglycemic agents on CRP blood levels

Abstract

Background: C-reactive protein (CRP) is linked to inflammation and elevated cardiovascular risk in metabolic disorders. Metformin has been shown to lower CRP concentrations. However, it is still unclear whether elevated CRP levels could be modulated by metformin. Objective: This study aims to evaluate the effects of metformin and its combinations on CRP levels in T2DM patients. Patients and Methods: a prospective comparative study was carried out at Tishreen University Hospital and some private diabetic clinics in Lattakia, Syria during the period between April 2020 and March 2022.The study included three groups of patients: group I (31 patients, 32.6%) received metformin at a dose of 1,000mg/d, group II (30 patients, 31.6%) received modified release gliclazide (60mg/d) and group III (34 patients, 35.8%) received metformin with sitagliptin (50/1000mg/d). CRP levels were measured at baseline and after 3 months of treatment. Results: a total of 95 patients, 55males (57.90%) and 40 females (42.1%) with a mean age of 50.72±6.6 years were included in the study. There were no significant differences between the three groups regarding age, sex, and BMI (p > 0.05). There was a significant decrease in FPG after treatment with metformin, gliclazide, and metformin with sitagliptin; 21.92%, 18.75%, and 24.39% respectively, p<0.0001. Metformin, gliclazide, and metformin with sitagliptin significantly reduced HbA1c by 18.7%, 17.36%, and 21.92% respectively. There was a significant change in CRP levels from baseline after receiving metformin (2.06±0.8 vs 3.46±0.9, p<0.001), and metformin with sitagliptin (1.84±0.6 vs 3.30±0.7, p:0<0001). However, the reduction in gliclazide group wasn’t significant (2.97±0.6 vs 3.14±1.1, p=0.09). Reduction in CRP levels wasn't influenced by age, sex or BMI, and was independent of glycemic control (p > 0.05). Conclusion: We demonstrated that metformin and its combination with sitagliptin have a favorable beneficial effect on inflammation marker CRP in patients with T2DM.