Metformin May Halt Childhood Diabetes

Obese children at risk of diabetes may benefit from metformin therapy

(RxWiki News) The growing obesity problem is not limited to adults. Children are a part of it too. As rates of childhood obesity grow, researchers are looking for ways to prevent childhood diabetes. A long-used drug may be one answer.

The drug metformin may improve body mass index (BMI) - a measure of body fat using height and weight - and blood sugar levels in obese children, according to a  study.

Childhood obesity has been linked to a lower insulin sensitivity and an increased risk of type 2 diabetes.

Results from the study showed that the total number of patients with high fasting insulin (a risk factor for diabetes) dropped by 16 percent among obese children taking metformin but increased by 14 percent in those taking placebo.

"Encourage your child to eat healthy and exercise."

Metformin has been used for decades as a first line treatment for type 2 diabetes. Insulin is a natural hormone that helps manage levels of sugar in the blood. In people with diabetes, the body does not properly use insulin, causing blood sugar levels to rise. To control this high blood sugar, the body may produce even more insulin.

Deborah Kendall, MD, of Royal Manchester Children's Hospital in the United Kingdom, and colleagues wanted to see how metformin treatment would affect severely obese children and teens. They found that metformin improved a number of risk factors associated with type 2 diabetes.

Compared to obese children treated with placebo, those treated with metformin had:

  • a lower BMI after 6 months
  • a greater reduction in fasting blood sugar after 3 months (reduction of 0.16 mmol/L)
  • greater improvement in levels of alanine transaminase, a measure of diabetes risk (19 percent improvement)
  • greater improvement in adiponectin to leptin ratio, another measure of diabetes and heart disease risk (32 percent improvement)

BMI is a measure of body fat. It can show whether someone is overweight, underweight or obese. A higher BMI is associated with a higher risk of diabetes and heart disease.

Fasting blood sugar measures how much sugar is in the blood when a patient has not eaten for a couple hours. Higher blood sugar is a sign of higher diabetes risk.

Alanine transaminase can also be a measure of diabetes risk. Higher levels of the substance may be a sign of higher diabetes risk.

An adiponectin to leptin ratio is a ratio of two substances in the body in which a higher number indicates a higher diabetes risk.

"Our findings provide evidence that a treatment course of metformin is clinically useful, safe and well tolerated in obese children who are at risk for type 2 diabetes," said Dr. Kendall.

Metformin treatment may also be the first boost children need to make lifestyle changes - such as a healthier diet and more exercise - that reduce the long-term risk for type 2 diabetes and related health problems, she said.

While this study showed that metformin can improve BMI and blood sugar levels in obese children, more research is needed to see if metformin treatment can reduce rates of type 2 diabetes among obese children, Dr. Kendall concluded.

According to Thomas M. Seman, MD, the president of North Shore Pediatrics and Boston Magazine's 'Best of Boston Pediatrician' in 2005, "Obesity in children is growing at an alarming rate and is present in approximately one-third of all children under 18 years old. This epidemic has put the future of this generation at risk to be the first generation that will be less healthy than the generation before."

The results of this study suggest that metformin could help children avoid serious health problems. However, Dr. Seman points out there are some rare but serious risks associated with metformin, including the risk of lactic acidosis - a condition in which lactic acid builds up in the blood, causing fatigue, muscle aches, dizziness and headaches among other symptoms.

To Dr. Seman, this study poses one main question: "Do we use metformin in children or not? The article points out that it can be very helpful in reducing insulin resistance and BMI, but every patient should be considered separately and individual risk evaluated."

"The use of [metformin] should be used judiciously as part of a total lifestyle management program (i.e., nutrition and exercise program). The goal should be to reduce the person's BMI, thus decreasing insulin resistance and reversing diabetes. If total body fat is reduced and exercise is maintained, one can actually resolve his or her type 2 diabetes, although he or she will be at risk for getting it again later on in life should he or she stop being careful," Dr. Seman explained.

Currently, metformin is not approved by the FDA to prevent diabetes in children.

The study included 151 obese young people. Due to the small size of the study, more research is needed to confirm the results.

The research was not funded by any specific grant from a funding agency in the public, commercial or not-for-profit sector. The authors reported no conflicts of interest. The study was published November 21 in the Journal of Clinical Endocrinology & Metabolism, a journal of The Endocrine Society.

Review Date: 
December 12, 2012