Background: Obesity in children is already a global health problem. Obese children and adolescents with insulin resistance 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 (CVD). Metformin is well-established oral hypoglycaemic agent in the treatment of adult and young patients with type 2 diabetes.
Objective and hypotheses: To analyse the effect of metformin treatment of obese children and adolescents with insulin resistance on the BMI, fasting serum glucose and insulin (calculated as insulin resistance index HOMA) and the ratio waist circumference:height (as a sign of abdominal adiposity and risk factor for metabolic syndrome, CVD, and type 2 DM).
Method: Investigation and follow up of 57 children and adolescents (16 boys), aged 7 years and 6 months16 years and 9 months. Patients received metformin for an average period of 14, 6 months (636 months) twice daily dosage of 10001700 mg. Anthropometry (height, weight, and waist circumference), clinical examination with regard to presence of acanthosis nigricans and oral glucose tolerance test were performed at baseline and end of treatment period.
Results: Mean age of subjects at baseline was 13 years and 7 months with median BMI 30 and 95 kg/m2 and waist circumference:height ratio 0:62. After the treatment period BMI was reduced with 1.91 kg/m2 and waist circumference:height ratio became 0:51. Acnathosis nigricans was found in 51% of all patients and pretreatment HOMA IR was 5.52. Metformin therapy had beneficial effect on HOMA which fall to 3.16.
Conclusion: Date from pediatric randomized controlled trials have shown that metformin use for the treatment of obese children and adolescents with insulin resistance lead to improvement in BMI, fasting serum glucose, and insulin and lipid profile as well as waist circumference:height ratio according to the results of the presented data.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology