Abstract
Author(s): Muntadher Noaman Jasim, Ahmed J. Mohammed
Diabetes is a diverse and intricate metabolic illness defined by high levels of glucose in the blood due to either resistance to insulin, inadequate production of insulin, or both. Metformin is one of the initial oral hypoglycemic agents frequently prescribed. Toll-like 4 receptors (TLR4) are receptors located on the surface of cells. It triggers the body's natural immune responses to harmful microorganisms by initiating a series of biochemical reactions that activate kinases and transcription factors. Two significant non-synonymous single nucleotide polymorphisms (SNPs) (rs4986790 and rs4986791) have been discovered in the coding region (exon 3) of the TLR4 gene. Methodology: This prospective cohort study included one hundred patients who were newly diagnosed with type 2 diabetes mellitus. The study was carried out at Al Diwaniyah Teaching Hospital, Diwaniya Governorate/ Iraq. The age varied, with a mean age of 55.25 and a standard deviation of 9.88. There was a 12-week interval between the first blood sample (taken at diagnosis when therapy was not yet underway) and the second (taken 12 weeks later) for every patient. Results: After administering metformin medication, there was a notable decrease in the average BMI (p < 0.01). The levels of fasting plasma glucose, plasma insulin, HbA1c, and insulin resistance (measured by the HOMA-IR index) were considerably decreased (p< 0.001), while there was a significant increase in insulin sensitivity (measured by the QUICKI) (p< 0.001). There was a substantial decrease in the average levels of lipid profiles (p< 0.001), except for an increase in the average HDL level. There was no significant linkage seen between TLR4 gene variant Asp299Gly and glycemic control, as measured by HbA1c levels below 7%, after therapy with metformin (p = 0.256). Conclusion: Metformin has demonstrated efficacy in enhancing serum lipid profiles, insulin levels, fasting plasma glucose, HbA1c, the insulin resistant index (HOMA-IR), and the insulin sensitivity index (QUICKI) in individuals diagnosed with type 2 diabetes mellitus. However, the TLR4 gene Asp299Gly polymorphism does not significantly correlate with glycemic control or response to metformin treatment.