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my personal edition > diabetes > news
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DGReview
Metformin May Improve Metabolic Control in Adolescents with Type I Diabetes
A DGReview of :"Metformin as additional therapy in adolescents with poorly controlled Type 1 diabetes. Randomised placebo-controlled trial with aspects on insulin sensitivity"
European Journal of Endocrinology
11/21/2003
By Keely S. Solomon, PhD
Metformin therapy may improve metabolic control in adolescents with poorly controlled type I diabetes, according to new research.
Children with type I diabetes frequently experience a substantial decrease in insulin sensitivity during puberty, which often leads to a decline in metabolic control despite increased insulin dosages.
"Thus, there is a great need for alternative therapeutic strategies in adolescents with type I diabetes," writes Stefan Sarnblad of the University Hospital, Orebro, Sweden. Dr. Sarnblad and colleagues performed a study to determine whether the addition of metformin therapy could improve glycaemic control and insulin sensitivity in adolescents with poorly controlled type I diabetes.
Twenty-six adolescents (mean age, 16.9 ± 1.6 years; 18 females) were randomised to receive either oral metformin or placebo for 3 months. Participants receiving metformin started with 500 mg daily for 1 week, followed by 500 mg twice daily for 3 weeks, and then 1000 mg twice daily for the rest of the study.
Mean glycated haemoglobin significantly decreased in the metformin group during the study period (9.6% to 8.7%; P < .05), but remained unchanged in the placebo group (9.5% vs. 9.2%; ns). Participants receiving metformin also experienced a significant increase in peripheral insulin sensitivity (P < .05), which was estimated by euglycaemic hyperinsulinaemic clamp.
In addition, the researcher noted that patients with a higher level of insulin-resistance showed greater improvements in both glycated haemoglobin and peripheral insulin sensitivity. They suggest that, "the main effect of metformin in adolescents with type I diabetes is associated with improved peripheral insulin sensitivity." This mechanism is in contrast to patients with type 2 diabetes, where the effect is predominately mediated by a decrease in hepatic glucose output.
No changes in weight or blood lipid levels occurred for either group, and no serious adverse effects were detected. Although previous studies have reported a reduced need for insulin in type I diabetes patients receiving metformin, a similar effect was not observed in the present study.
"Adjunctive therapy with metformin in adolescents with type I diabetes is efficacious and safe, " the researchers conclude. However, they add that "further, larger studies carried out over longer time periods, are recommended."
Eur J Endocrinol 2003 Oct;149:4:323-9.
"Metformin as additional therapy in adolescents with poorly controlled Type 1 diabetes. Randomised placebo-controlled trial with aspects on insulin sensitivity"
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