Konrad Katja, Datz Nicolin, Engelsberger Ilse, Grulich-Henn Jürgen, Hoertenhuber Thomas, Knauth Burkhild, Meissner Thomas, Wiegand Susanna, Woelfle Joachim, Holl Reinhard W
Department of Pediatrics II, University Children's Hospital Essen, Essen, Germany.
Department of Pediatrics, ''Auf der Bult" Hannover, Hannover, Germany.
Pediatr Diabetes. 2015 Nov;16(7):529-37. doi: 10.1111/pedi.12203. Epub 2014 Aug 18.
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.
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.
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.
Additional metformin therapy in T1DM is primarily used in obese females. Additional therapy with metformin was associated with minor benefits.
随着儿童和青少年肥胖率的上升，1型糖尿病（T1DM）患者体重增加和胰岛素抵抗也愈发常见。尤其是在青春期，胰岛素治疗往往需要强化，需要更高的胰岛素剂量。一些研究指出，在这些患者中，二甲双胍联合胰岛素治疗有有益效果。为了描述当前的治疗实践及可能的益处，我们在前瞻性多中心分析中，将接受胰岛素联合二甲双胍治疗的儿科T1DM患者（n = 525）与仅接受胰岛素治疗的患者（n = 57487）进行了比较。
对德国/奥地利糖尿病患者病程记录（DPV）登记处中58012例年龄小于21岁的T1DM患者的生长发育及治疗数据进行多变量混合回归建模分析。
加用二甲双胍的患者年龄更大[中位数（四分位间距）]：[16.1（14.1 - 17.6）岁对15.2（11.5 - 17.5）岁]，女性占比更高（61.0%对47.2%，p < 0.01）。他们的体重指数标准差评分（BMI-SDS）更高[+2.03（+1.29至+2.56）对+0.51（-0.12至+1.15）；p < 0.01]，糖化血红蛋白（HbA1c）水平也更高（9.0%对8.6%，p < 0.01）。高血压（43.7%对24.8%）和血脂异常（58.4%对40.6%）的患病率显著更高。调整后的胰岛素剂量显著更高（0.98对0.93 IU/kg体重）。在285例纵向随访的患者亚组中（平均治疗期1.42年），加用二甲双胍导致BMI-SDS略有降低[-0.01（-2.01至+1.40）]，但未改善HbA1c或胰岛素需求量。
T1DM患者加用二甲双胍治疗主要用于肥胖女性。二甲双胍辅助治疗的益处较小。
