ESPE Abstracts

Introduction: The prevalence of childhood obesity is increasing worldwide, and the management remains a challenge. The mainstay of management is lifestyle modification but if this is not successful, pharmacological agents are considered although the options in children and young people are quite limited. Metformin has been used as an adjunct therapy alongside lifestyle modification in children and young people with obesity. Some studies have shown it to be effective in the short term but evidence regarding long-term benefits is limited.

Aim: The aim of our study was to investigate the effect of long-term metformin use on the body mass index (BMI) in children and young people with obesity.

Method: Retrospective data from a single tertiary children’s hospital was collected over 2 years period. Children and adolescents aged 10-18 years with a BMI (SDS) > 2 and on metformin therapy for at least 2 years were identified. Patients with type 2 diabetes mellitus were excluded. All patients had demonstrated insulin resistance prior to commencing metformin therapy. Change in BMI was compared at 6, 12 and 24 months to baseline measurements.

Results: In total, 43 patients were included (27 F: 16 M) with a mean age of 13.44 years (± 3.42). The starting dose of metformin was 500mg daily and it was increased to a maximum dose of 2g daily over the course of 24 months. The mean baseline BMI and BMI SDS were 37.33 (± 8.35) and 3.78 (± 1.05) respectively. The mean BMI (SD) at 6 months was 36.82 (± 8.84), at 12 months was 37.41 (± 8.81) and at 24 months was 37.72 (± 8.03). There was an initial drop in BMI in the first 6 months but subsequently the BMI increased till the end of the 2 years study period. Only 5 out of the 43 patients achieved 5% weight loss at the end of 24 months. The patients who discontinued treatment prior to the two years period (not included in the analysis) did so predominantly due to gastrointestinal side effects.

Conclusion: The results of the study have shown that metformin therapy over two-years was not effective in reducing weight in children and adolescents with obesity. Newer treatment options are needed to manage childhood obesity, along with intense lifestyle intervention, in a multidisciplinary team setting.