Särnblad Stefan, Kroon Marianne, Aman Jan
Department of Paediatrics, University Hospital, Orebro, Sweden.
Eur J Endocrinol. 2003 Oct;149(4):323-9. doi: 10.1530/eje.0.1490323.
Metabolic control often deteriorates during puberty in children with type 1 diabetes. The aim of the present study was to investigate whether addition of metformin for 3 Months improves metabolic control and insulin sensitivity.
Twenty-six of 30 randomised adolescents with type 1 diabetes (18 females, eight males) completed a double-blind placebo-controlled trial. Their mean age was 16.9+/-1.6 (s.d.) Years, mean glycated haemoglobin (HbA(1c)) 9.5+/-1.1% and daily insulin dosage 1.2+/-0.3 U/kg. The participants were randomised to receive oral metformin or placebo for 3 Months. HbA(1c) was measured Monthly, and peripheral insulin sensitivity was assessed by a euglycaemic hyperinsulinaemic clamp at baseline and at the end of the study.
HbA(1c) decreased significantly in the group treated with metformin, from 9.6 to 8.7% (P<0.05), but was unchanged in the placebo group (9.5 vs 9.2%). Peripheral glucose uptake divided by mean plasma insulin concentration was increased in the metformin group (P<0.05) but not in the placebo group. Initial insulin sensitivity was inversely correlated to changes in HbA(1c) (r=-0.62; P<0.05) and positively correlated to changes in insulin sensitivity (r=0.77; P<0.01).
In this double-blind placebo-controlled study we found that metformin improves metabolic control in adolescents with type 1 diabetes. The effect seems to be associated with an increased insulin-induced glucose uptake.
1型糖尿病儿童在青春期时代谢控制常常恶化。本研究的目的是调查添加二甲双胍治疗3个月是否能改善代谢控制及胰岛素敏感性。
30名随机分组的1型糖尿病青少年（18名女性，8名男性）中有26人完成了一项双盲安慰剂对照试验。他们的平均年龄为16.9±1.6（标准差）岁，平均糖化血红蛋白（HbA1c）为9.5±1.1%，每日胰岛素剂量为1.2±0.3U/kg。参与者被随机分配接受口服二甲双胍或安慰剂治疗3个月。每月测量HbA1c，并在基线和研究结束时通过正常血糖高胰岛素钳夹技术评估外周胰岛素敏感性。
二甲双胍治疗组的HbA1c显著下降，从9.6%降至8.7%（P<0.05），而安慰剂组则无变化（9.5%对9.2%）。二甲双胍组外周葡萄糖摄取量除以平均血浆胰岛素浓度增加（P<0.05），而安慰剂组未增加。初始胰岛素敏感性与HbA1c的变化呈负相关（r=-0.62；P<0.05），与胰岛素敏感性的变化呈正相关（r=0.77；P<0.01）。
在这项双盲安慰剂对照研究中，我们发现二甲双胍可改善1型糖尿病青少年的代谢控制。这种作用似乎与胰岛素诱导的葡萄糖摄取增加有关。
