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Long-term follow-up of non-diabetic obese children and adolescents treated with metformin

Year 2019, Volume: 10 Issue: 1, 57 - 61, 21.03.2019
https://doi.org/10.18663/tjcl.498721

Abstract

Aim: Childhood obesity is an important public health
problem with increasing prevalence.Type 2 diabetes mellitus(T2DM) is strongly
associated with obesity and metabolic syndrome. Adressing obesity and insulin
resistance by drug treatment represents a rational strategy for the prevention
of T2DM.
The aim of our study was to evaluate the
one year metformin treatment’slong-term effectiveness in children and
adolescent.

Material
and Methods:
Patients who were diagnosed with obesity (VKİ>+2
SDS)
and found to have insulin resistance
(total insulin at OGTT >300 mIU/ml and homa-IR >3.4)and other obesity co-morbidities, agedbetween
10-18 years, treated with metformin in addition to lifestyle change for a year and
with regular follow-up for a minimum of 2 years after metformin treatmentin our
clinicwere included inthe study.

Results:
A total of 12 cases including 8 girls with
a mean age of 13.2±2.1 years and mean follow-up duration of 3.9±1 years were
included in the study. While the body mass index (BMI) of the cases at
presentation was 31.2±5.6 kg/m2 and BMI-SDS was 2.7±0.7, the BMI-SDS
value after one year of metformin treatment was found to have regressed to 1.9±1
(p:0.04), and the BMI-SDS value two years after the interruption of metformin
treatment had increased to 2.1±1.04 but was not as high as the period before
metformin treatment (p:0.033).







Conclusion:
One-year metformin treatment improved the
BMI SDS and homa-IR values of the obese children and this improvement decreased
but continued in the second year after the discontinuation of the treatment.

References

  • 1. McDonagh MS, Selph S, Ozpınar A, Foley C. Systematic reviewof the benefits and risks ofmetforminin treating obesity in children aged 18 years and younger. JAMA Pediatr 2014; 168: 178-84
  • 2. Ho M, Garnet SP, Baur LA. Childhood Obesity and Insulin Resistance: How should It be Managed?.Curr Treat Cardio Med 2014; 16: 351
  • 3. WangY, Lobstein T. Worldwide trends in childhood overweight and obesity. IntJ PediatrObes, 2006; 1: 11-25
  • 4. van der Aa MP, Elst MA, van Mil EG, Knibbe CA, van der Vorst MM. METFORMIN: an efficacy, safety and pharmacokinetic study on the short-term and long-term use in obese children and adolescents - study protocol of a randomized controlled study. Trials 2014; 15: 207
  • 5. BrufaniC, Crino A, Fintini D, Patera IP, Cappa M, Manco M. Systematic Review of Metformin Use in Obese Nondiabetic Children and Adolescents. Horm Res Paediatr 2013; 80: 78-80
  • 6. Park MH, Kinra S, Ward KI,White B, VinerRM. Metformin for obesity in children and adolescents: a systematicreview. Diabetes Care 2009; 32: 1743-45 7. Freemark M, Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics 2001; 107: 55
  • 8. Srinivasan S, Ambler GR, Baur LA, Garnett SP, Tepsa M, Yap F, Ward GM, Cowell CT. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. J ClinEndocrinolMetab 2006; 91: 2074–80
  • 9. Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metab 2008; 21: 339–48
  • 10. Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD, Hill DJ. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine 2009; 36: 141–46
  • 11. Wiegand S, l’Allemand D, Hübel H, Krude H, Bürmann M, Martus P, Grüters A, Holl RW. Metformin and placebo therapy both improve weight management and fasting insulin in obese insulin resistant adolescents: a prospective, placebo-controlled, randomized study. Eur J Endocrinol 2010; 163: 585–92
  • 12. Wilson D.M, Abrams SH, Aye T, Lee PDK, Lenders C, Lusting RH, OsganianSV, Feldman HA. Metformin extended release treatment of adolescent obesity. Arch PediatrAdolescMed 2010; 164: 116-23
  • 13. Rynders C, Weltman A, Delgiorno C, Balagopal P, Damaso L, Killen K, Mauras N. Lifestyle intervention improves fitness independent of metformin in obese adolescents. Med Sci Sports Exerc 2012; 44: 786–92
  • 14. Mauras N, DelGiorno C, Hossain J, Bird K, Killen K, Merinbaum D, Weltman A, Damaso L, Balagopal P. Metformin use in children with obesity and normal glucose toleranceeffects on cardiovascular markers and intrahepatic fat. J PediatrEndocrinolMetab 2012; 25: 33–40
  • 15. Weiss R, Kaufman FR. Metabolic complications of childhood obesity: identifying and mitigating the risk. DiabetesCare 2008; 31: 310-16
  • 16. MatthaeiS, Stumvoll M, Kellerer M, Haring HU. Pathophysiology and pharmacological treatment of insulin resistance. Endocr Rev 2000; 21: 585-618
  • 17. Cali AM, Man CD, Cobelli C, Dziura J, Seyal A, Shaw M, Allen K, Chen S, Caprio S. Primary defects in ß-cell function further exacerbated by worsening of insulin resistance mark the development of impaired glucose tolerance in obese adolescents. Diabetes Care 2009; 32: 456-61

Metformin ile tedavi edilen non-diyabetik obez çocuk ve adolesanların uzun sureli izlemi

Year 2019, Volume: 10 Issue: 1, 57 - 61, 21.03.2019
https://doi.org/10.18663/tjcl.498721

Abstract

Amaç: Çocukluk döneminde obezite artan sıklıkla izlenen önemli bir halk
sağlığı problemidir.  Tip 2 Diyabetes mellitus
(T2DM) obezite ve metabolik sendrom ile güçlü ilişki içindedir. Tip 2 DM ‘nin
önlenmesi için obezite ve insulin direncini hedef alan ilaç tedavileri rasyonel
bir strateji olarak görülmektedir.Çalışmamızın amacı bir yıl süre ile metformin
tedavisi alan çocuk ve adolesanlarda bu tedavinin uzun dönem etkinliğini
değerlendirmektir.

Gereç ve Yöntemler: Kliniğimizde obezite (VKI>+ 2SDS ) tanısı alan ve insulin direnci olan
(OGTT’de total insulin düzeyi >300
mIU/ml ve homa IR >3,4
) ve diğer obezite ilişkili komorbiditeleri bulunan, yaşları 10-18 arası
değişen, yaşam tarzı değişikliği ile birlikte bir yıl süre ile metformin
tedavisi alan ve ardından en az iki yıl süre ile takip edilen hastalar dahil
edildi.

Bulgular: Çalışmaya
8’ i kız , ortalama yaşı 13,2±2,1 yıl olan 
ve ortalama izlem süresi 3,9±1 yıl olan toplam 12 dahil edildi.
Başlangıçta  olguların vücut kitle
indeksi (VKİ) 31,2±5,6 kg/m2ve VKİ-SDS’i 2,7±0,7 iken bir yıllık
metformin tedavisi ile VKİ-SDS’inin 1,9±1 (p:0,04) ‘ e gerilediği, iki yıl süre
ile metformin tedavisi kesilen olguların 
VKİ-SDS’ inin 2,1±1,04 (p:0,033)’ e yükseldiği ancak metformin tedavisi
öncesi kadar yüksek olmadığı görüldü.







Sonuç: Bir yıllık metformin
tedavisinin obez çocuk ve adolesanlarda VKİ-SDS ve  Homa-IR değerlerinde düzelme sağladığı, bu
düzelmenin tedavi kesiminden sonraki ikinci yılda da azalmakla birlikte devam
ettiği saptandı. 

References

  • 1. McDonagh MS, Selph S, Ozpınar A, Foley C. Systematic reviewof the benefits and risks ofmetforminin treating obesity in children aged 18 years and younger. JAMA Pediatr 2014; 168: 178-84
  • 2. Ho M, Garnet SP, Baur LA. Childhood Obesity and Insulin Resistance: How should It be Managed?.Curr Treat Cardio Med 2014; 16: 351
  • 3. WangY, Lobstein T. Worldwide trends in childhood overweight and obesity. IntJ PediatrObes, 2006; 1: 11-25
  • 4. van der Aa MP, Elst MA, van Mil EG, Knibbe CA, van der Vorst MM. METFORMIN: an efficacy, safety and pharmacokinetic study on the short-term and long-term use in obese children and adolescents - study protocol of a randomized controlled study. Trials 2014; 15: 207
  • 5. BrufaniC, Crino A, Fintini D, Patera IP, Cappa M, Manco M. Systematic Review of Metformin Use in Obese Nondiabetic Children and Adolescents. Horm Res Paediatr 2013; 80: 78-80
  • 6. Park MH, Kinra S, Ward KI,White B, VinerRM. Metformin for obesity in children and adolescents: a systematicreview. Diabetes Care 2009; 32: 1743-45 7. Freemark M, Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics 2001; 107: 55
  • 8. Srinivasan S, Ambler GR, Baur LA, Garnett SP, Tepsa M, Yap F, Ward GM, Cowell CT. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. J ClinEndocrinolMetab 2006; 91: 2074–80
  • 9. Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metab 2008; 21: 339–48
  • 10. Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD, Hill DJ. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine 2009; 36: 141–46
  • 11. Wiegand S, l’Allemand D, Hübel H, Krude H, Bürmann M, Martus P, Grüters A, Holl RW. Metformin and placebo therapy both improve weight management and fasting insulin in obese insulin resistant adolescents: a prospective, placebo-controlled, randomized study. Eur J Endocrinol 2010; 163: 585–92
  • 12. Wilson D.M, Abrams SH, Aye T, Lee PDK, Lenders C, Lusting RH, OsganianSV, Feldman HA. Metformin extended release treatment of adolescent obesity. Arch PediatrAdolescMed 2010; 164: 116-23
  • 13. Rynders C, Weltman A, Delgiorno C, Balagopal P, Damaso L, Killen K, Mauras N. Lifestyle intervention improves fitness independent of metformin in obese adolescents. Med Sci Sports Exerc 2012; 44: 786–92
  • 14. Mauras N, DelGiorno C, Hossain J, Bird K, Killen K, Merinbaum D, Weltman A, Damaso L, Balagopal P. Metformin use in children with obesity and normal glucose toleranceeffects on cardiovascular markers and intrahepatic fat. J PediatrEndocrinolMetab 2012; 25: 33–40
  • 15. Weiss R, Kaufman FR. Metabolic complications of childhood obesity: identifying and mitigating the risk. DiabetesCare 2008; 31: 310-16
  • 16. MatthaeiS, Stumvoll M, Kellerer M, Haring HU. Pathophysiology and pharmacological treatment of insulin resistance. Endocr Rev 2000; 21: 585-618
  • 17. Cali AM, Man CD, Cobelli C, Dziura J, Seyal A, Shaw M, Allen K, Chen S, Caprio S. Primary defects in ß-cell function further exacerbated by worsening of insulin resistance mark the development of impaired glucose tolerance in obese adolescents. Diabetes Care 2009; 32: 456-61
There are 16 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Melikşah Keskin

Zehra Aycan This is me

Uğur Ufuk Işın

Semra Çetinkaya

Publication Date March 21, 2019
Published in Issue Year 2019 Volume: 10 Issue: 1

Cite

APA Keskin, M., Aycan, Z., Işın, U. U., Çetinkaya, S. (2019). Long-term follow-up of non-diabetic obese children and adolescents treated with metformin. Turkish Journal of Clinics and Laboratory, 10(1), 57-61. https://doi.org/10.18663/tjcl.498721
AMA Keskin M, Aycan Z, Işın UU, Çetinkaya S. Long-term follow-up of non-diabetic obese children and adolescents treated with metformin. TJCL. March 2019;10(1):57-61. doi:10.18663/tjcl.498721
Chicago Keskin, Melikşah, Zehra Aycan, Uğur Ufuk Işın, and Semra Çetinkaya. “Long-Term Follow-up of Non-Diabetic Obese Children and Adolescents Treated With Metformin”. Turkish Journal of Clinics and Laboratory 10, no. 1 (March 2019): 57-61. https://doi.org/10.18663/tjcl.498721.
EndNote Keskin M, Aycan Z, Işın UU, Çetinkaya S (March 1, 2019) Long-term follow-up of non-diabetic obese children and adolescents treated with metformin. Turkish Journal of Clinics and Laboratory 10 1 57–61.
IEEE M. Keskin, Z. Aycan, U. U. Işın, and S. Çetinkaya, “Long-term follow-up of non-diabetic obese children and adolescents treated with metformin”, TJCL, vol. 10, no. 1, pp. 57–61, 2019, doi: 10.18663/tjcl.498721.
ISNAD Keskin, Melikşah et al. “Long-Term Follow-up of Non-Diabetic Obese Children and Adolescents Treated With Metformin”. Turkish Journal of Clinics and Laboratory 10/1 (March 2019), 57-61. https://doi.org/10.18663/tjcl.498721.
JAMA Keskin M, Aycan Z, Işın UU, Çetinkaya S. Long-term follow-up of non-diabetic obese children and adolescents treated with metformin. TJCL. 2019;10:57–61.
MLA Keskin, Melikşah et al. “Long-Term Follow-up of Non-Diabetic Obese Children and Adolescents Treated With Metformin”. Turkish Journal of Clinics and Laboratory, vol. 10, no. 1, 2019, pp. 57-61, doi:10.18663/tjcl.498721.
Vancouver Keskin M, Aycan Z, Işın UU, Çetinkaya S. Long-term follow-up of non-diabetic obese children and adolescents treated with metformin. TJCL. 2019;10(1):57-61.


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