Current use of metformin in addition to insulin in pediatric patients with type 1 diabetes mellitus: an analysis based on a large diabetes registry in Germany and Austria

Abstract

Additional metformin therapy in T1DM is primarily used in obese females. Additional therapy with metformin was associated with minor benefits.

Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States

“…Greater attention to avoidance of excessive caloric intake and better food choices early in the treatment of T1D, encouragement of regular physical activity, reduced screen time, and the elimination of unnecessary snacks are among the factors that could play roles in achieving and maintaining healthy weights in this population. Given the challenges of preventing and treating obesity in youth with T1D who receive intensive treatment, adjunctive therapies to insulin, like metformin, GLP1 agonists and SGLT2 inhibitors that have been shown to lower HbA1c and body weight in adults with T2D, could be important additions to current options for care in youth with T1D (29,30).…”

The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta-analysis

“…Higher BMI, especially during adolescence period, is linked to negative body image, poor psychosocial outcomes, and poor metabolic control among diabetic children . In addition, our results are inline with German/Austrian registry data for children with T1DM . The registry followed 57 487 children, mean age 15.5 years who received insulin, and 525 patients who received metformin in addition to insulin.…”

“…Typically, T1DM control worsens during adolescents’ period secondary to increase body weight, and insulin resistance as a result of the raising puberty hormones . Accordingly, many clinicians have used metformin as an off‐label medication to improve metabolic control based on the experience with type 2 diabetes mellitus patients, and small‐for‐gestational‐age children who are at risk for central adiposity and hyperinsulinemia . Metformin is an insulin‐sensitizing agent that works by increasing the glucose uptake variably in the muscle through amplification of the glucose transporters 4, and reduced hepatic glucose production, thus improving tissue sensitivity to insulin …”

Metformina: más allá del control glucémico

“…La metformina es un antidiabético oral, del grupo de las biguanidas, primera línea de tratamiento de los pacientes con DM2 7 y casos puntuales de Diabetes Mellitus tipo 1 (DM1) 8 . Mucho antes que se conocieran claramente los mecanismos de acción a nivel molecular, la metformina se postuló como primera opción de tratamiento por el beneficio al aumentar la sensibilidad a la insulina en los tejidos periféricos y, por la consecuente, disminución en la resistencia a esta, con poco riesgo de hipoglucemia y disminución discreta del peso 9 ; además, por demostrar en ensayos clínicos, la reducción del riesgo de complicaciones macrovasculares que son la mayor causa de morbimortalidad en el paciente con DM2 10 .…”

“…Con el aumento en la prevalencia de la obesidad en niños y adolescentes, la resistencia a la insulina se hace cada vez más frecuente en los pacientes con DM1, durante la pubertad este fenómeno se incrementa y los pacientes pueden incluso desarrollar síndrome metabólico, lo que obliga a aumentar los requerimientos de insulina, pero, también con los efectos deletéreos que esto implica. Según este principio fisiopatológico, el uso de metformina podría ser beneficioso en los pacientes niños y adolescentes con DM1 con sobrepeso u obesidad que desarrollen resistencia a la insulina 8 .…”