Desilets Alicia R, Dhakal-Karki Sushmita, Dunican Kaelen C
Massachusetts College of Pharmacy and Health Sciences-Worcester/Manchester, Manchester, NH 03101, USA.
Ann Pharmacother. 2008 Jun;42(6):817-26. doi: 10.1345/aph.1K656. Epub 2008 May 13.
To evaluate the efficacy and safety of metformin for weight management in overweight and obese patients without type 2 diabetes.
Literature was obtained through MEDLINE Ovid (1950-February week 3, 2008), EMBASE (all years), and a bibliographic review of relevant articles. Key words included metformin, obesity, overweight, and weight loss.
STUDY SELECTION/DATA EXTRACTION: All studies published in the English language that evaluated the effects of metformin on weight in obese or overweight individuals were critically analyzed. Relevant articles were selected for inclusion in this review.
Metformin is first-line pharmacotherapy in the treatment of overweight or obese patients with type 2 diabetes, with beneficial effects on weight in this population. Multiple trials have evaluated the effect of metformin on weight and other metabolic parameters in adults and adolescents without diabetes. Five of 12 trials in adults evaluated weight loss as a primary endpoint. Significant weight reduction was found in 4 of these studies; however, the trials were small and of weak design. Weight reduction was significant in 5 of the 6 adolescent trials; similarly, these studies were limited by weak study design and small patient population. Metabolic parameters (blood pressure, waist circumference, cholesterol parameters, insulin/glucose levels) often showed varying results. Metformin was well tolerated; gastrointestinal effects were the most frequently reported adverse effects.
The weight loss effects of metformin in overweight or obese adults and adolescents without diabetes appear promising; however, trials have been limited by small patient populations and weak design. Metformin may also have a positive effect on metabolic parameters such as waist circumference, fasting insulin and glucose levels, and triglycerides. Further research involving large-scale trials that evaluate weight loss as a primary outcome is necessary to firmly establish the role of metformin in this population.
评估二甲双胍对无2型糖尿病的超重和肥胖患者体重管理的疗效及安全性。
通过MEDLINE Ovid（1950年 - 2008年2月第3周）、EMBASE（所有年份）及相关文章的文献综述获取文献。关键词包括二甲双胍、肥胖症、超重和体重减轻。
研究选择/数据提取：对所有以英文发表的、评估二甲双胍对肥胖或超重个体体重影响的研究进行严格分析。选取相关文章纳入本综述。
二甲双胍是治疗2型糖尿病超重或肥胖患者的一线药物治疗方法，对该人群的体重有有益影响。多项试验评估了二甲双胍对无糖尿病的成人和青少年体重及其他代谢参数的影响。12项成人试验中有5项将体重减轻作为主要终点。其中4项研究发现体重显著减轻；然而，这些试验规模较小且设计薄弱。6项青少年试验中有5项体重减轻显著；同样，这些研究也因研究设计薄弱和患者群体规模小而受到限制。代谢参数（血压、腰围、胆固醇参数、胰岛素/血糖水平）的结果往往各不相同。二甲双胍耐受性良好；胃肠道效应是最常报告的不良反应。
二甲双胍对无糖尿病的超重或肥胖成人及青少年的减肥效果似乎很有前景；然而，试验因患者群体规模小和设计薄弱而受到限制。二甲双胍可能对腰围、空腹胰岛素和血糖水平以及甘油三酯等代谢参数也有积极影响。有必要进行进一步的大规模试验，将体重减轻作为主要结局进行评估，以牢固确立二甲双胍在该人群中的作用。
