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Item #4 

Metformin A Therapy in Adolescents With Type 1 Diabetes and Insulin Resistance

Metformin treatment lowered HbA_1c and decreased insulin dosage with no weight gain in teens with type 1 diabetes in poor metabolic control.

The study objective was to evaluate whether, in adolescents with type 1 diabetes, the addition of metformin to insulin and standard diabetes management results in 1) higher insulin sensitivity and 2) lower HbA_1c, fasting glucose, insulin dosage (units per kilogram per day) and BMI.

The study was a randomized, placebo-controlled 3-month trial of metformin therapy in 27 adolescents with type 1 diabetes, high insulin dosage (>1 unit · kg^-1 · day^-1), and HbA_1c >8%, with measurements of insulin sensitivity (by frequently sampled intravenous glucose tolerance test [FSIGT]), HbA_1c, insulin dosage, and BMI at the onset and end of treatment.

The results at t = 0, HbA_1c was 9.2 ± 0.9%, insulin dosage was 1.2 ± 0.2 units · kg^-1 · day^-1, fasting glucose was 10.6 ± 2.4 mmol/l, and BMI was 24.2 ± 3.9 kg/m² (means ± SD), with no difference between the metformin and placebo groups. At the end of the study, HbA_1c was 0.6% lower in the metformin group than in the placebo group (P < 0.05). This was achieved at lower daily insulin dosages (metformin group –0.14 ± 0.1 vs. placebo group 0.02 ± 0.2 units · kg^-1 · day^-1; P < 0.05), with no significant change in BMI. Fasting glucose levels improved significantly in the metformin group (P < 0.05). Change in insulin sensitivity, measured by FSIGT, was not significantly different between the two groups at study end. Mild hypoglycemia occurred more frequently in the metformin-treated than in the placebo subjects (1.75 ± 0.8 vs. 0.9 ± 0.4 events · patient^-1 · week^-1; P = 0.03). There were no differences in frequency of severe hypoglycemic episodes or gastrointestinal complaints between the two groups.

From the results it was concluded that metformin treatment lowered HbA_1c and decreased insulin dosage with no weight gain in teens with type 1 diabetes in poor metabolic control. Changes in insulin sensitivity were not documented in this study using the FSIGT. Long-term studies will determine whether these improvements are sustained and whether certain subgroups accrue greater benefit from this therapy.  

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DID YOU KNOW:

Studies show that fewer than one in five American men seek immediate medical care when sick or in pain. When it comes to men and their health, the statistics are alarming. In one survey conducted by the Commonwealth Fund, a private foundation that supports research on health and social issues, men were found to visit the doctor three times less than women. 41 percent of men polled said if they were sick they would delay seeing a doctor for a least a week or as long as possible. Many men failed to get routine checkups, preventive care, or health counseling, and often ignored symptoms.