The mechanisms causing vascular complications in diabetes are poorly understood. One potential mechanism is the induction of vascular complications by increased formation of advanced glycation endproducts (AGEs) by hyperglycemia. Various deleterious effects are attributed to these AGEs including the production of reactive oxygen species, resulting in proinflammatory cellular responses. Although the formation of AGEs is complex, it is well established that α-dicarbonyls compounds such 3-deoxyglucosone (3DG). The levels of 3DG have been shown to be elevated in patients with diabetes.

Metformin has been reported to reduce α-dicarbonyl levels. However, it is unclear if this is the result of a direct action in reducing the levels of α-dicarbonyls or if it is because of an improvement in glycemic control.

Engelen et al. therefore conducted a single center, double-masked, double-dummy, crossover study to compare the effects of metformin versus repaglinide, an antihyperglycemic agent with an insulin-secreting mechanism on the levels of 3DG in 96 nonobese type 2 diabetic patients. They found that both metformin and repaglinide induced an improvement in glycemic control associated with a reduction ion 3DG levels. They thus conclude that this could constitute a metabolic pathway through which both treatments have a beneficial impact on the cardiovascular risk profile. Engelen et al. (2011) European Journal of Endocrinology 164 371-379.

Read the full article at DOI: 10.1530/EJE-10-0851.