Urakami Tatsuhiko, Morimoto Shigeo, Owada Misao, Harada Kensuke
Department of Pediatrics, Nihon University School of Medicine, Chiyoda-ku, Tokyo, Japan.
Pediatr Int. 2005 Aug;47(4):430-3. doi: 10.1111/j.1442-200x.2005.02075.x.
The aim of this study was to evaluate the effect of metformin in addition to insulin therapy in adolescents and young adults with type 1 diabetes mellitus.
Nine patients, two males and seven females, aged 18.1 +/- 3.0 years, with type 1 diabetes mellitus were studied. They were relatively overweight with a body mass index (BMI) of 24.2 +/- 1.8 and had high levels of HbA1c at 9.5 +/- 1.2% despite high doses of insulin of 74.0 +/- 31.2 U/day. Metformin at the dose of 500-750 mg daily was administered to the patients in addition to insulin therapy for 1 year.
HbA1c, BMI and insulin dose were compared before 1 year without metformin therapy, at baseline, and at 3, 6 and 12 months during the use of metformin in addition to insulin therapy. HbA1c lowered (8.6 +/- 1.4**, 8.4 +/- 1.3**, 8.4 +/- 1.2*%), BMI was reduced (23.9 +/- 1.7*, 23.8 +/- 1.8, 23.5 +/- 1.8*), and insulin requirement decreased (69.8 +/- 29.7*, 68.7 +/- 29.8**, 67.3 +/- 29.1**U/d) significantly after the start of metformin therapy (*P < 0.05, **P < 0.01 vs at baseline). There were no adverse events, not even lactic acidosis, during the study period.
Metformin is safe and may represent a useful adjunct to the management of type 1 diabetes mellitus in adolescents and young adults who have poor glycemic control despite a large amount of insulin.
本研究旨在评估二甲双胍联合胰岛素治疗对1型糖尿病青少年及青年患者的疗效。
对9例1型糖尿病患者进行研究，其中男性2例，女性7例，年龄18.1±3.0岁。他们相对超重，体重指数（BMI）为24.2±1.8，尽管每日胰岛素剂量高达74.0±31.2 U，但糖化血红蛋白（HbA1c）水平仍高达9.5±1.2%。除胰岛素治疗外，患者每日服用500 - 750 mg二甲双胍，共治疗1年。
比较了患者在未使用二甲双胍治疗的1年之前、基线时以及联合使用二甲双胍和胰岛素治疗的3、6和12个月时的HbA1c、BMI和胰岛素剂量。开始使用二甲双胍治疗后，HbA1c显著降低（8.6±1.4**，8.4±1.3**，8.4±1.2*%），BMI降低（23.9±1.7*，23.8±1.8，23.5±1.8*），胰岛素需求量减少（69.8±29.7*，68.7±29.8**，67.3±29.1**U/d）（与基线相比，*P<0.05，**P<0.01）。研究期间未出现不良事件，甚至未发生乳酸性酸中毒。
对于尽管使用大量胰岛素但血糖控制仍不佳的1型糖尿病青少年及青年患者，二甲双胍是安全的，且可能是一种有用的辅助治疗药物。
