Current use of metformin in addition to insulin in pediatric patients with type 1 diabetes mellitus: an analysis based on a large diabetes registry in Germany and Austria. Issue 7 (18th August 2014)

• Record Type: Journal Article
• Authors: Konrad, Katja; Datz, Nicolin; Engelsberger, Ilse; Grulich‐Henn, Jürgen; Hoertenhuber, Thomas; Knauth, Burkhild; Meissner, Thomas; Wiegand, Susanna; Woelfle, Joachim; Holl, Reinhard W.; for the German/Austrian DPV Initiative
• Is Part Of: Pediatric diabetes. Volume 16:Issue 7(2015:Nov.)
• Page Start: 529
• Page End: 537
• Publication Date: 2014-08-18
• Subjects: Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.12203
• Languages: English
• ISSNs: 1399-543X

Abstract

<abstract abstract-type="main" id="pedi12203-abs-0001"> <title>Abstract</title> <sec id="pedi12203-sec-0001" sec-type="section"> <title>Background</title> <p id="pedi12203-para-0001">With increasing obesity in childhood and adolescence, weight gain, and insulin resistance become also more frequent in patients with type 1 diabetes mellitus (T1DM). Especially during puberty, insulin therapy often has to be intensified and higher insulin doses are necessary. Some studies point to a beneficial effect of metformin in addition to insulin in these patients. In order to describe current practice and possible benefits, we compared pediatric T1DM patients with insulin plus metformin (n = 525) to patients with insulin therapy only (n = 57 487) in a prospective multicenter analysis.</p> </sec> <sec id="pedi12203-sec-0002" sec-type="section"> <title>Methods</title> <p id="pedi12203-para-0002">Auxological and treatment data from 58 012 patients aged <21 yr with T1DM in the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry were analyzed by multivariable mixed regression modeling.</p> </sec> <sec id="pedi12203-sec-0003" sec-type="section"> <title>Results</title> <p id="pedi12203-para-0003">Patients with additional metformin were older [median (interquartile range)]: [16.1 (14.1–17.6) vs. 15.2 (11.5–17.5) yr] with female preponderance (61.0 vs. 47.2%, p < 0.01). They had higher body mass index‐standard deviation score (BMI‐SDS) [+2.03 (+1.29 to +2.56) vs. +0.51 (−0.12 to +1.15); p < 0.01] and glycated hemoglobin (HbA1c) (9.0 vs. 8.6%, p < 0.01). Hypertension (43.7 vs. 24.8%) and dyslipidemia (58.4 vs. 40.6%) were significantly more prevalent. Adjusted insulin dose was significantly higher (0.98 vs. 0.93 IU/kg bodyweight). In a subgroup of 285 patients followed‐up longitudinally (average treatment period 1.42 yr), addition of metformin resulted in a slight reduction of BMI‐SDS [−0.01 (−2.01 to +1.40)], but did not improve HbA1c or insulin requirement.</p> </sec> <sec id="pedi12203-sec-0004" sec-type="section"> <title>Conclusion</title> <p id="pedi12203-para-0004">Additional metformin therapy in T1DM is primarily used in obese females. Additional therapy with metformin was associated with minor benefits.</p> </sec> </abstract>