Introduction: Obesity in children and adolescents is a growing global health problem. Obese children and adolescents provide the pediatric healthcare professionals management challenge. Obesity with insulin resistance, dyslipidemia and elevated blood pressure constitute the metabolic syndrome and each of these is an independent risk factor for cardiovascular disease, diabetes mellitus, non-alcoholic fatty liver disease. Lifestyle modification is a primary and main milestone in treatment, but often has short or limited effect. On the other hand metformin is well established oral hypoglycemic agent in the treatment of adult and young patients with type 2 diabetes.
Objective: To evaluate the effect of metformin treatment in children and adolescents on the body mass index (BMI), fasting serum glucose and insulin (calculated as Homeostasis model assessment for Insulin resistance HOMA-IR) and blood glucose at the second hour of an oral glucose tolerance test (OGTT). In addition we examined secondary health outcomes as total cholesterol, tryglycerides, HDL- and LDL- cholesterol and blood pressure.
Methods: Investigation and follow up of 57 children and adolescents (16 boys), aged 7 years 6 months-16 years 9 months. Patients received Metformin for an average period of 14,6 months (6-36 months) twice daily dosage of 10001700 mg. Anthropometry (height, weight, waist circumference), clinical examination with regard to presence of acanthosis nigricans (AN) and hypertension (AH) (systolic and/or diastolic blood pressure above 95 percentile for age, gender and height), serum lipid level, liver enzymes, OGTT were performed at baseline, every six months and end of treatment period.
Results: At evaluation and beginning of treatment median BMI was 30.95 kg/m2. After the treatment period BMI was reduced with 1.91 kg/m2. AN was found in 51% of all patients and pretreatment HOMA-IR was 5.52. Metformin therapy had beneficial effect both on HOMA-IR which fall to 3.16 and the presence of AN which was found in 27 patients (47.3%). Of all patients 21% (12) were found to have Impaired glucose tolerance before treatment and only one at the end of treatment. Total cholesterol was average 4.34 mmol/l and fall to 4.11 mmol/l (P>0.05). Reduction of other lipids was found but also without statistical significance. AH was found in 26 patients (45.5%) at beginning and in 25.7% after treatment.
Conclusion: Metformin can be efficacious treatment that lead to improvement in BMI, HOMA-IR, IGT and AH in obese children and adolescents but although it has lowering effect on serum lipids it does not show statistical significance.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology