Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Horm Res Paediatr. 2013;80(2):78-85. doi: 10.1159/000353760. Epub 2013 Jul 26.
Childhood obesity has become epidemic and has been accompanied by an increase in prevalence of type 2 diabetes (T2DM) in youth. Addressing obesity and insulin resistance by drug treatment represents a rational strategy for the prevention of T2DM. A systematic review was performed to evaluate the effectiveness of metformin in reducing weight and ameliorating insulin resistance in obese nondiabetic children.
A PubMed database search was conducted, using 'metformin', 'obesity', 'insulin resistance', 'children', 'adolescents' as search terms.
Eleven trials were included in the present review. Metformin was administered for 6-12 months at a dosage of 1,000-2,000 mg/daily, decreasing BMI by 1.1-2.7 compared with placebo or lifestyle intervention alone. Concomitantly, fasting insulin resistance improved after metformin therapy. Posttreatment follow-up was performed in one study, showing that after 1 year of discontinuation of therapy the decrease in BMI disappears.
Short-term metformin treatment appears to moderately affect weight reduction in severely obese children and adolescents, with a concomitant improvement in fasting insulin sensitivity. Further studies with longer treatment period are needed to establish how much metformin can reduce weight and its real utility in preventing T2DM development in pediatric patients.
儿童肥胖症已呈流行趋势，并伴随着青少年 2 型糖尿病（T2DM）发病率的上升。通过药物治疗来解决肥胖和胰岛素抵抗问题，代表了预防 T2DM 的一种合理策略。本系统评价旨在评估二甲双胍在减轻肥胖非糖尿病儿童体重和改善胰岛素抵抗方面的有效性。
使用“二甲双胍”、“肥胖”、“胰岛素抵抗”、“儿童”、“青少年”作为检索词，在 PubMed 数据库中进行检索。
本综述共纳入 11 项试验。二甲双胍的剂量为 1,000-2,000mg/天，治疗时间为 6-12 个月，与安慰剂或单纯生活方式干预相比，可使 BMI 降低 1.1-2.7。同时，二甲双胍治疗后空腹胰岛素抵抗得到改善。有一项研究进行了治疗后随访，结果显示治疗 1 年后停止治疗后 BMI 的下降消失。
短期二甲双胍治疗似乎可适度减轻严重肥胖儿童和青少年的体重，同时改善空腹胰岛素敏感性。需要进行更长治疗时间的进一步研究，以确定二甲双胍能减轻多少体重以及其在预防儿科患者 T2DM 发展方面的实际效用。
