Predictors of insulin resistance and the effect of Metformin treatment in obese pediatric patients
 
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Gallen H*, Banerjee I**, Clayton PE***, Ehtisham S****, Padidela R*****, Patel L******, Skae M*******
MUMPS Conference, October 2015, UK*, MUMPS Conference, October 2015, UK**, MUMPS Conference, October 2015, UK***, MUMPS Conference, October 2015, UK****, MUMPS Conference, October 2015, UK*****, MUMPS Conference, October 2015, UK******, MUMPS Conference, October 2015, UK*******
Background
Paediatric obesity is a growing concern for the health service. There is currently no consensus for routine screening of metabolic profiles and medical treatment in obese paediatric patients.
Methods
We aimed to determine medium-term outcomes of metformin treatment on body mass index (BMI), glucose and insulin levels in obese paediatric patients. In a retrospective review, data were collected from obese paediatric patients on metformin for insulin resistance between October 2009 and October 2014. Changes in BMI SDS, glucose and insulin were analysed. Paired sample t-tests were used to compare pre and post treatment results (treatment washout period of 1 month).
Results
Seventy patients were treated with metformin (50=female) (35=British White, 18=Pakistani) at a mean age of 12.7 (6.1-17.2) years. Mean BMI was 35.2 (24.2-48.5 kg/m2) and BMI SDS was 3.4 (2.2-4.7). All patients with a family history of Type 2 diabetes mellitus (DM) had acanthosis nigricans (AN). All patients with AN (n=43, 49% with no family history of T2 DM) had insulin resistance with significantly higher basal insulin levels (p<0.05) than those without. Metformin was associated with reduced BMI z-score at 6-12 months (-0.1 SDS, p<0.05) and 18-24 months (-0.2 SDS, p<0.05). Reduction in fasting and postprandial glucose levels were (-0.1 mmol/L, p=0.17) and (-0.5 mmol/L, p=0.17) respectively, with a significant reduction in postprandial glucose levels in those patients with impaired glucose tolerance (n=13) (-1.9 mmol/L, p<0.05). Metformin was associated with a reduction in fasting insulin (-3.0 mU/L,p=0.44), and significantly reduced 2 hour insulin (-118.0 mU/L ,p<0.05) after treatment for 12-18 months.
Conclusion
Metformin treatment is significantly associated with reduction in BMI z-score from 6 months and reduced postprandial insulin levels after treatment. It should be considered as a treatment modality in normoglycaemic obese paediatric patients for weight stabilisation and improvement of insulin resistance, which may have longer term implications on metabolic health.
 
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H G, I B, PE C, S E, R P, L P, M S.. Available From : http://www.pediatriconcall.com/conference/abstract/35/view/841
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