Original Article

Retrospective Chart Review of Children With Type 2 Diabetes Mellitus Evaluating the Efficacy of Metformin vs. Insulin vs. Combination Insulin/Metformin

Authors: Stacy L. Meyer, MD, Robert P. Hoffman, MD

Abstract

Objectives: Type 2 diabetes mellitus is a growing problem in pediatrics and there is no consensus on the best treatment. We conducted this chart review on newly diagnosed pediatric patients with type 2 diabetes mellitus to compare the effect of treatment regimen on body mass index (BMI) and hemoglobin A1c over a 6-month period.


Methods: We conducted a retrospective chart review on patients with type 2 DM who presented to Nationwide Children's Hospital. Data were collected on therapy type, BMI, and hemoglobin A1c over a 6-month follow-up. Therapy type was divided into metformin, insulin, or combination insulin and metformin. 1,997 charts were reviewed for inclusion based on ICD-9 codes consistent with a diagnosis of diabetes, abnormal oral glucose tolerance test, or insulin resistance.


Results: Of the 47 charts eligible for the review, 26 subjects were treated with metformin 1000-1500 mg daily, 14 patients were treated with insulin therapy, and 7 patients were treated with a combination of insulin and metformin therapy. At baseline, the only significant difference among groups was A1c (P = 0.012). In regression analysis with baseline A1c as a covariate, the only predictor of change in A1c over time was the A1c at onset (P < 0.001). Therapy type was not predictive of change (P = 0.905). Regression analysis showed a greater BMI at onset predicted a greater decrease in BMI (P = 0.006), but therapy type did not predict a change (P = 0.517).


Conclusion: Metformin may be as effective as insulin or combination therapy for treatment of diabetes from onset to 6-month follow-up.

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References

1. The Writing Group for the SEARCH for Diabetes in Youth Study Group. Incidence of diabetes in youth in the United States. JAMA 2007;297:2716-27224.
 
2. Rosenbloom AL, Joe JR, Young R, et al. The emerging epidemic of type 2 diabetes mellitus in youth.Diabetes Care 1999;22:345-354.
 
3. American Diabetes Association. Type 2 diabetes in children and adolescents (consensus statement). Diabetes Care 2000;23:381-389.
 
4. Kaufman FR. Type 2 diabetes mellitus in children and youth: a new epidemic. J Pediatr Endocrinol Metab 2002;15(2 suppl):737-744.
 
5. Stumvoll M, Nurjhan N, Perriello G, et al. Metabolic effects of metformin in non-insulin dependent diabetes mellitus. N Engl J Med 1995;333:558-559.
 
6. Cusi K, Consoli A, DeFronzo RA. Metabolic effects of metformin on glucose and lactate metabolism in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1996;81:4059-4067.
 
7. Gram J, Henriksen JE, Grodum E, et al. Pharmacological treatment of the pathogenetic defects in Type 2 diabetes. The randomized multi-centre South Danish Diabetes Study (SDDS) [published online October 7, 2010]. Diabetes Care 2010.
 
8. Defronzo R, Barzilai N, Simonson C. Mechanism of metformin action in obese and lean noninsulin-dependent diabetic subjects. J Clin Endocrinol Metab 1991;73:1294-1301.
 
9. Jones KL, Arslanian S, Peterokova V, et al. Effect of metformin in pediatric patients with type 2 diabetes. Diabetes Care 2002;25:89-94.
 
10. Rosenbloom AL, Silverstein JH, Amemiya S, et al. Type 2 diabetes in children and adolescents. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Pediatr Diabetes 2009;10(12 suppl):17-32.
 
11. Perriello G, Pampanelli S, Del Sindaco P, et al. Evidence of increased systemic glucose production and gluconeogenesis in an early stage of NIDDM. Diabetes 1997;46:1010-1016.
 
12. Gulli G, Ferranini E, Stern M, et al. The metabolic profile of NIDDM is fully established in glucose-tolerant offspring of two Mexican-American NIDDM parents. Diabetes 1992;41:1575-1586.
 
13. Warram JH, Martin BC, Krolewski AS, et al. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Ann Intern Med 1990;113:909-915.
 
14. Perriello G, Misericordia P, Volpi E, et al. Acute antihyperglycemic mechanisms of metformin in NIDDM. Evidence of suppression of lipid oxidation and hepatic glucose production. Diabetes1994;43:920-928.
 
15. Caton PW, Nayuni NK, Kieswish J, et al. Metformin suppresses hepatic gluconeogenesis through induction of SIRT1 and GCN5. J Endocrinol 2010;205:97-106.
 
16. Schuster D, Kien CL, Osei K. Differential impact of obesity on glucose metabolism in black and white American adolescents. Am J Med Sci 1998;316:361-367.
 
17. Schuster D, Gaillard T, Rhinesmith S, et al. Impact of metformin on glucose metabolism in nondiabetic, obese African Americans. A placebo-controlled, 24-month randomized study. Diabetes Care 2004;11:2768-2769.
 
18. Cheng V, Kashyap S. Weight considerations in pharmacotherapy for type 2 diabetes. J Obes [Epub ahead of print Sep 19, 2010].
 
19. Park MH, Kinra S, Ward K, et al. Metformin for obesity in children and adolescents: a systematic review. Diabetes Care 2009;32:1743-1745.
 
20. Rezvanian H, Hashemipour M, Kelishadi R, et al. A randomized, triple masked, placebo-controlled clinical trial for controlling childhood obesity. World J Pediatr 2010;6:317-322.
 
21. Golay A. Metformin and body weight. Int J Obes 2008;32:61-72.