Improvement of Glycemic Control by Metformin Is Associated With Frequency of Defecation Before Treatment in Patients With Type 2 Diabetes Mellitus
Bibliographic record
Abstract
Background: It was recently reported that metformin induces glucose excretion in the terminal ileum. This study reassessed the ability of metformin to promote defecation and its relationship with the glycated hemoglobin (HbA 1c ) level in patients with type 2 diabetes mellitus (T2DM). Methods: We retrospectively assessed the frequency of defecation (FD) in patients with T2DM who were admitted to our hospital for glycemic control between April 2017 and March 2022. We examined the FD associated with initiation of metformin or a sodium-glucose cotransporter-2 inhibitor (SGLT2i) by calculating the change in FD after starting treatment (DeltaFD). Next, we compared the FD variables (DeltaFD, the FD ratio and FD before and after starting treatment) and the change in glycated hemoglobin (DeltaHbA 1c ) at 1.5 and 6 months after discharge between the two treatment groups with no change in medications except for minor adjustments in the insulin dose. Results: Fifty-five patients were included (metformin group, n = 30; SGLT2i group, n = 25). The mean FD increased significantly after the maximum dose was reached in the metformin group (from 0.70 ± 0.19 to 0.83 ± 0.18 times/day; P = 0.001) but not in the SGLT2i group. Surprisingly, there was no significant relationship between DeltaFD or the FD ratio before and after starting treatment and the DeltaHbA 1c in either treatment group. However, there was a significant correlation of FD before and after starting metformin with the DeltaHbA 1c (r = -0.467, P = 0.009 and r = -0.509, P = 0.004, respectively). Multivariate analysis found a significant correlation of FD before and after starting metformin with DeltaHbA 1c (P < 0.05). However, there was no correlation of FD with DeltaHbA 1c before or after starting an SGLT2i. Conclusions: Metformin improves HbA 1c in patients with T2DM in an FD-associated manner but not in an FD change-associated manner. Given that DeltaHbA 1c was associated with FD both after and before starting metformin, we suggest that the effects of this agent may be influenced by the pretreatment FD as well as conventional dose dependence. However, metformin did increase the FD, but the reason for this phenomenon is currently unknown. J Endocrinol Metab. 2023;13(4):153-163 doi: https://doi.org/10.14740/jem916
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".