ESPE Abstracts

Objective: The majority of studies have focused on evaluating metformin as an additional therapy for T1DM, neglecting its potential as a standalone treatment for early-onset T1DM in obese individuals without ketosis. This case report presents two instances where metformin monotherapy effectively managed T1DM in children with early-onset and obesity-related conditions.

Introduction: The association between obesity and T1DM has garnered significant scientific attention, prompting exploration of precision medicine approaches such as anti-obesity pharmacotherapy, oral hypoglycemic agents, and bariatric surgery for optimal management of this specific patient subset. However, the question of whether daily multiple insulin injections are necessary for individuals diagnosed early with preserved beta cell function, who may respond well to oral metabolic therapies like metformin, remains insufficiently investigated.

Methods: In this two-year prospective trial, we extensively examined two overweight children who were diagnosed with early-stage T1DM, which was defined by symptomatic hyperglycemia without ketosis, positive antibodies, and Both of our cases also had a relatively late onset, which was consistent with the preserved beta cell function due to normal insulin and C-peptide levels. Metformin was initially administered to these patients until the condition progressed to the point that insulin Multiple Daily Injections (MDI) were required.

Results: In both cases, the children initially responded well to lifestyle modifications and metformin therapy. They showed improvements in glycemic control and reduction in BMI. However, over time, their blood sugar control worsened, leading to the need for insulin therapy. The duration until insulin dependency varied, with the first patient requiring insulin after one year and the second patient after two years. These cases highlight the challenges of managing diabetes in young individuals and the progressive nature of the disease despite initial treatment success with metformin.

Conclusion: Our findings demonstrated the positive impact of metformin monotherapy in improving glycemic control, facilitating weight loss, and delaying the initiation of insulin treatment in children with late-onset and early-stage T1DM, while preserving beta cell function and managing obesity. Although metformin monotherapy for T1DM necessitates further research, it can be considered as an adjunct or alternative therapy in specific cases, particularly for those with late-onset T1DM, preserved beta cell function, and obesity-related insulin resistance. However, additional studies are warranted to establish the optimal utilization of metformin in T1DM and to ascertain its long-term safety and efficacy.