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The Use Of Metformin In Type 1 Diabetes A Systematic Review Of Efficacy

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The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy.

The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy.

The use of metformin in type 1 diabetes: a systematic review of efficacy. Biomedical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK. Diabetologia. 2010 May;53(5):809-20. doi: 10.1007/s00125-009-1636-9. Epub 2010 Jan 8. AIMS/HYPOTHESIS: As adding metformin to insulin therapy has been advocated in type 1 diabetes, we conducted a systematic review of published clinical trials and clinical trial databases to assess the effects on HbA(1c), weight, insulin-dose requirement and adverse effects. METHODS: We constructed evidence tables and fitted a fixed-effects model (inverse variance method) in order to assess heterogeneity between studies and give a crude measure of each overall treatment effect. RESULTS: Of 197 studies identified, nine involved randomisation with informed consent of patients with type 1 diabetes to metformin (vs placebo or comparator) in either a parallel or crossover design for at least 1 week. We noted marked heterogeneity in study design, drug dose, age of participants and length of follow-up. Metformin was associated with reductions in: (1) insulin-dose requirement (5.7-10.1 U/day in six of seven studies); (2) HbA(1c) (0.6-0.9% in four of seven studies); (3) weight (1.7-6.0 kg in three of six studies); and (4) total cholesterol (0.3-0.41 mmol/l in three of seven studies). Metformin was well tolerated, albeit with a trend towards increased hypoglycaemia. Formal estimates of combined effects from the five trials which reported appropriate data indicated a significant reduction in insulin dose (6.6 U/day, p < 0.001) but no significant reduction in HbA(1c) (absolute reduction 0.11%, p = 0.42). No reported trials included cardiovascular outcomes. CONCLUSIONS/INTERPRETATION: Metformin reduces insulin-dose Continue reading >>

Metformin For Type 2 Diabetes Mellitus. Systematic Review And Meta-analysis | Atencin Primaria

Metformin For Type 2 Diabetes Mellitus. Systematic Review And Meta-analysis | Atencin Primaria

Aten Primaria 2005;36:183-91 - DOI: 10.1157/13078602 Metformin for Type 2 Diabetes Mellitus. Systematic Review and Meta-Analysis A. Senz Calvo a , I. Fernndez Esteban b , A. Mataix Sanjun b , M. Ausejo Segura c , M. Roqu d , D. Moher e a Centro de Salud Pozuelo 1, ??rea 6, Instituto Madrile??o de la Salud, Pozuelo de Alarc??n, Madrid, Spain. b ??rea 11, Instituto Madrile??o de la Salud, Madrid, Spain. c Servicio de Evaluaci??n del Gasto Farmac??utico, Direcci??n General de Farmacia, Consejer??a de Sanidad y Consumo, Madrid, Spain. d Centro Cochrane Iberoamericano, Servicio de Epidemiolog??a, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain e Director del Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada. Versin en Espaol: Metformina para la diabetes mellitus tipo 2. Revisin sistemtica y metaanlisis Objective . To evaluate the efficacy of metformin against placebo, diet, oral anti-diabetics, or insulin in type 2 diabetes mellitus. Design. Systematic review. Data sources. MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003). Selection of studies. 29 randomized clinical trials of metformin in monotherapy, with results on mortality, morbility, and biochemistry. Extraction of data. RevMan 4 computer program. Two reviewers extracted the data and evaluated the quality. Main variables: any clinical event related to diabetes (mortality, coronary disease, stroke, arterial disease, and retinopathy). Secondary variables: weight and biochemistry. Results. 29 clinical studies with 37 comparisons of metformin were analyzed (13 with sulphonylureas, 12 with placebo, 3 with diet, 3 with thiazolidinediones, 2 with *-glucosidase inhibitors, 2 with insulin, and 2 with meglitinides). Metformin w Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Metformin

Metformin

Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>

Efficacy And Safety Of Liraglutide Versus Sitagliptin Both In Combination With Metformin In Patients With Type 2 Diabetes: A Systematic Review And Meta-analysis

Efficacy And Safety Of Liraglutide Versus Sitagliptin Both In Combination With Metformin In Patients With Type 2 Diabetes: A Systematic Review And Meta-analysis

Diabetes mellitus (DM) is a chronic metabolic disease with main clinical etiologies of hyperglycemia and microvascular complications, and hyperglycemia primary resulting from defects in insulin secretion, insulin action, or both. [1] Globally, there are 415 million people with diabetes and the death toll of diabetes hit 5 million in 2015; moreover, the diabetes population is expected to rise to 642 million by 2040. [2] DM was divided into type 1and type 2 diabetes, and about 90% of DM patients are diagnosed with type 2 DM (T2DM). Good glycemic control plays an vital role in regulating blood glucose balance and reducing the occurrence of microvascular complications, including nephropathy, neuropathy, and retinopathy. [3] Unfortunately, the traditional therapeutic drugs for T2DM could not effectively control hyperglycemia, and frequently occurring side effects remain a big problem. Metformin, a synthetic biguanide considered as the first-line oral hypoglycemic agent can be used for monotherapy and combination therapy for T2DM; this recommendation is based on metformin's glucose-lowering effects, lower level of side effects, and cost. [4] According to the prospective study of United Kingdom, metformin could reduce the risk of diabetes-related complications and mortality; metformin not only exercised strong control in blood glucose levels of obese patients with T2DM but also proved to be effective in normal-weight patients. [5] Initially, metformin monotherapy is often effective, although the effect of glucose control is limited after all, so a second agent is often required in most patients. Currently, metformin can be combined with insulin secretagogue, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like polypeptide-1 (GLP-1) agonist to reduce gly Continue reading >>

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Abstract Objectives To compare the benefits and harms of metformin and insulin versus insulin alone as reported in randomised clinical trials of patients with type 2 diabetes. Design Systematic review of randomised clinical trials with meta-analyses and trial sequential analyses. Data sources The Cochrane Library, Medline, Embase, Science Citation Index Expanded, Latin American Caribbean Health Sciences Literature, and Cumulative Index to Nursing and Allied Health Literature until March 2011. We also searched abstracts presented at the American Diabetes Association and European Association for the Study of Diabetes Congresses, contacted relevant trial authors and pharmaceutical companies, hand searched reference lists of included trials, and searched the US Food and Drug Administration website. Review methods Two authors independently screened titles and abstracts for randomised clinical trials comparing metformin and insulin versus insulin alone (with or without placebo) in patients with type 2 diabetes, older than 18 years, and with an intervention period of at least 12 weeks. We included trials irrespective of language, publication status, predefined outcomes, antidiabetic interventions used before randomisation, and reported outcomes. Results We included 26 randomised trials with 2286 participants, of which 23 trials with 2117 participants could provide data. All trials had high risk of bias. Data were sparse for outcomes relevant to patients. Metformin and insulin versus insulin alone did not significantly affect all cause mortality (relative risk 1.30, 95% confidence interval 0.57 to 2.99) or cardiovascular mortality (1.70, 0.35 to 8.30). Trial sequential analyses showed that more trials were needed before reliable conclusions could be drawn regarding these outcom Continue reading >>

Efficacy And Safety Of Metformin For Patients With Type 1 Diabetes Mellitus: A Meta-analysis

Efficacy And Safety Of Metformin For Patients With Type 1 Diabetes Mellitus: A Meta-analysis

Efficacy and Safety of Metformin for Patients with Type 1 Diabetes Mellitus: A Meta-Analysis Background: Insulin is an essential therapy for patients with type 1 diabetes mellitus (T1DM). With the progression of the disease, many patients with T1DM may have an increased prevalence of insulin resistance; thus the common standard insulin therapy requires a high insulin dosage (>1 unit/kg/day) and is usually associated with many side effects. Studies have shown that metformin may benefit those insulin-resistant individuals with T1DM. This meta-analysis was performed to provide the evidence of clinical efficacy and safety of metformin in T1DM. Materials and Methods: We conducted a search on Medline, EMBASE, and the Cochrane Library for relevant studies published before May 2014 based on metformin and diabetes mellitus, type 1. The following outcomes were evaluated: hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), lipid metabolism, weight, insulin dosage, hypoglycemia, diabetic ketoacidosis, or gastrointestinal adverse events (AEs). The meta-analysis was performed using Review Manager version 5.2 software (The Nordic Cochrane Centre, Copenhagen, Denmark). Results: In total, eight randomized controlled trials were included. Metformin was associated with a reduction in daily insulin dosage, body weight, total cholesterol level, low-density lipoprotein level, and high-density lipoprotein level but an increase in risk of gastrointestinal AEs compared with placebo treatment in T1DM patients. No significant difference was found between the metformin group and the placebo group in HbA1c level, FPG level, or triglycerides level. No significant difference was found between the metformin group and the placebo group in the risk of severe hypoglycemia or diabetic ketoacidosis. Con Continue reading >>

Does Metformin Reduce Cardiovascular Disease In Type 1 Diabetes? | Touchendocrinology

Does Metformin Reduce Cardiovascular Disease In Type 1 Diabetes? | Touchendocrinology

Does metformin reduce cardiovascular disease in type 1 diabetes? Sayed Mia, Endocrinology Account Director, Touch Medical Media, UK Katrina Mountfort, Senior Medical Writer, Touch Medical Media, UK -Insights into the REMOVAL Study, presented at the ADA, 77th Scientific Sessions, San Diego, CA, June 11th 2017 The life expectancy of people with type 1 diabetes (T1D) is reduced by an average of 11 to 13 years.1 Tight glycaemic control using intensive insulin therapy is essential to reduce microvascular complications in T1D.2 However, insulin therapy requires a high degree of support and may cause hypoglycaemia and weight gain.3 Metformin is commonly prescribed as adjuvant therapy to reduce insulin dose requirement and prevent weight gain.4 In recent years, there has been an increased focus on macrovascular complications of T1D, in particular cardiovascular disease.5 The rates of cardiovascular events in patients with T1D are more than double those in the general population and account for around 45% of deaths.6 Metformin has been associated with reduced cardiovascular mortality in patients with type 2 diabetes,7 as well as patients with ST-segment elevation myocardial infarction (STEMI) without diabetes.8 Investigators therefore wondered whether the cardiovascular impact of metformin would be similar in patients with T1D. The double blind, placebo controlled REMOVAL (REducing with MetfOrmin Vascular Adverse Lesions in type 1 diabetes) study was undertaken at 23 hospital diabetes clinics in five countries (Australia, Canada, Denmark, the Netherlands, and the UK).9 Individuals aged 40 years or over with T1D of at least five years duration were eligible if they had at least 3 of 10 specified CV risk factors. A total of 428 adults were randomized to daily metformin 1000 mg tw Continue reading >>

The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy.

The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy.

The use of metformin in type 1 diabetes: a systematic review of efficacy. Recommended by Kyong Soo Park and Soo Heon Kwak I found this article interesting because it addresses the efficacy of metformin in type 1 diabetes patients. This systematic review shows that metformin is associated with decreased total daily dose of insulin and might be a good adjunctive treatment in addition to insulin therapy for type 1 diabetes subjects. It is not unusual to see overweight or even obese type 1 diabetes patients in the clinic. Since increasing the dose of... To read the rest of this recommendation and access over 145,000 article recommendations from 3,700+ journals across biomedicine, register Send a recommendation to your institution's librarian or information manager to request an extended free trial for articles in biology and medicine, contributed inclusion in F1000Prime to help you filter recommendations, plus relevant articles as engine clusters of related articles and be alerted as soon as similar articles appear in If you think you should be able to access this content, please contact us . If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not recognised, please try again We are unable to reset your password, please contact [email protected] to reactivate your account, quoting error code UACC/DEL You registered with F1000 via Google, so we cannot reset your password. If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. If you still need help with your Facebook account password, please click here . You regi Continue reading >>

The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy

The Use Of Metformin In Type 1 Diabetes: A Systematic Review Of Efficacy

Abstract As adding metformin to insulin therapy has been advocated in type 1 diabetes, we conducted a systematic review of published clinical trials and clinical trial databases to assess the effects on HbA1c, weight, insulin-dose requirement and adverse effects. We constructed evidence tables and fitted a fixed-effects model (inverse variance method) in order to assess heterogeneity between studies and give a crude measure of each overall treatment effect. Of 197 studies identified, nine involved randomisation with informed consent of patients with type 1 diabetes to metformin (vs placebo or comparator) in either a parallel or crossover design for at least 1 week. We noted marked heterogeneity in study design, drug dose, age of participants and length of follow-up. Metformin was associated with reductions in: (1) insulin-dose requirement (5.7–10.1 U/day in six of seven studies); (2) HbA1c (0.6–0.9% in four of seven studies); (3) weight (1.7–6.0 kg in three of six studies); and (4) total cholesterol (0.3–0.41 mmol/l in three of seven studies). Metformin was well tolerated, albeit with a trend towards increased hypoglycaemia. Formal estimates of combined effects from the five trials which reported appropriate data indicated a significant reduction in insulin dose (6.6 U/day, p < 0.001) but no significant reduction in HbA1c (absolute reduction 0.11%, p = 0.42). No reported trials included cardiovascular outcomes. Metformin reduces insulin-dose requirement in type 1 diabetes but it is unclear whether this is sustained beyond 1 year and whether there are benefits for cardiovascular and other key clinical outcomes. Notes We acknowledge the assistance of N. Waugh (University of Aberdeen) and R. McAlpine (NHS Tayside). J. R. Petrie is a member of the Steering Group of Continue reading >>

Is Metformin Effective For Type 1 Diabetes?

Is Metformin Effective For Type 1 Diabetes?

Is Metformin Effective for Type 1 Diabetes? At what point, if any, should one consider the addition of metformin to the regimen of an adherent patient with type 1 diabetes who is not well controlled on insulin? Associate Professor, Department of Pharmacy Practice, Presbyterian College School of Pharmacy; Clinical Pharmacy Specialist, Good Shepherd Free Medical Clinic, Clinton, South Carolina The addition of off-label metformin to insulin therapy to improve insulin sensitivity, promote weight control, and reduce insulin dose requirements in patients with type 1 diabetes has been assessed in systematic reviews.[ 1 , 2 ] One review sought to assess the effects of metformin when added to insulin therapy for type 1 diabetes in adolescents.[ 1 ] The Cochrane Library, MEDLINE, and EMBASE were searched, along with databases of ongoing clinical trials, for randomized controlled trials of at least 3 months' duration. Trials that were included compared metformin added to insulin vs insulin therapy alone. Two trials met inclusion criteria, representing 60 patients in total. Although a lack of heterogeneity made meta-analysis impossible, the authors did note that both studies found a reduction in glycosylated hemoglobin A1c values when metformin was added to insulin. One of the studies also showed a 10% decrease in insulin dosage among those taking metformin. Hypoglycemia and gastrointestinal disturbances were among the most commonly occurring adverse effects of combination therapy. Another systematic review evaluated the addition of metformin to insulin in type 1 diabetes.[ 2 ] This review identified 9 studies, including both adolescents and adults, that involved randomization with informed consent. The studies compared metformin vs placebo or another comparator in parallel or cro Continue reading >>

A Randomized, Double-blind, Placebo-controlled Trial Of Adjunctive Metformin Therapy In Overweight/obese Youth With Type 1 Diabetes

A Randomized, Double-blind, Placebo-controlled Trial Of Adjunctive Metformin Therapy In Overweight/obese Youth With Type 1 Diabetes

A Randomized, Double-Blind, Placebo-Controlled Trial of Adjunctive Metformin Therapy in Overweight/Obese Youth with Type 1 Diabetes * E-mail: [email protected] Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Affiliation Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, Massachusetts, 01655, United States of America Continue reading >>

The Efficacy And Safety Of Sglt2 Inhibitors For Adjunctive Treatment Of Type 1 Diabetes: A Systematic Review And Meta-analysis

The Efficacy And Safety Of Sglt2 Inhibitors For Adjunctive Treatment Of Type 1 Diabetes: A Systematic Review And Meta-analysis

Article | Open The efficacy and safety of SGLT2 inhibitors for adjunctive treatment of type 1 diabetes: a systematic review and meta-analysis Scientific Reports volume 7, Articlenumber:44128 (2017) To assess the efficacy and safety of the SGLT-2 inhibitors as adjunct therapy to insulin in T1DM, clinical trials indexed in PubMed, Cochrane Library, EMbase from inception through April 5, 2016. A meta-analysis was conducted on trials of SGLT-2 inhibitors in patients with T1DM on insulin therapy using RevMan 5.3 software. Of the 371 articles identified, ten met eligibility criteria. Seven clinical trials including four randomized controlled trials and 581 patients were included. Compared with the control group, SGLT-2 inhibitors group had significantly reduced fasting plasma glucose by 0.69 mmol/L [1.32; 0.07], glycosylated hemoglobin A1C by 0.37% [0.54; 0.20], body weight by 2.54 kg [3.48; 1.60] and total daily insulin dose by 6.22 IU [8.04; 4.40]. The total incidence of adverse events (AEs), hypoglycemia, and genital and urinary infections were also similar to placebo, while an increased incidence of diabetic ketoacidosis (DKA) (n = 16) was seen in SGLT-2 inhibitors group. The present study demonstrates that SGLT-2 inhibitors are effective as adjunct therapy to insulin in T1DM, heralding improved glycemic control, reduced body weight and total daily insulin dose without an increase in total AEs, hypoglycemia, or genital and urinary infections. However, the risk of DKA should be carefully monitored in future clinical trials. Diabetes mellitus (DM) is the seventh leading cause of mortality worldwide, with a continually increasing prevalence and incidence 1 . Globally, in 2015 the disease prevalence was 415 million adults, with an estimated 318 million people at risk for dev Continue reading >>

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards of Care, the ADA Professional Practice Committee did MEDLINE searches from 1 January 2016 to November 2016 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards of Care were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendation: This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes. The American Diabetes Association (ADA) first released its practice guidelines for health professionals in 1989. The Standards of Medical Care in Diabetes have since provided an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards of Care cover all aspects of patient care (1); this guideline synopsis focuses on monitoring and pharmacologic approaches for patients with type 1 diabetes. Guideline Development and Evidence Grading Monitoring Glycemia in Type 1 Diabetes Glycemic Goals: Recommendations Pharmacologic Therapy for Type 1 Diabetes: Recommendations Continue reading >>

The Effect Of Metformin On Adolescents With Type 1 Diabetes: A Systematic Review And Meta-analysis Of Randomized Controlled Trials

The Effect Of Metformin On Adolescents With Type 1 Diabetes: A Systematic Review And Meta-analysis Of Randomized Controlled Trials

The Effect of Metformin on Adolescents with Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 1Department of Cardiology, Guizhou Provincial Peoples Hospital, Guizhou 550002, China 2Department of Endocrinology, Guizhou Provincial Peoples Hospital, Guizhou 550002, China Received 2 March 2016; Revised 21 May 2016; Accepted 5 June 2016 Copyright 2016 Wei Liu and Xiao-Jie Yang. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The effect of metformin in combination with insulin in adolescents with type 1 diabetes (T1DM) is controversial. Methods and Results. The PubMed and EMBASE online databases were searched. Five double-blind randomized controlled trials (RCTs) that included 301 adolescents with T1DM were identified. Metformin plus insulin was associated with reduced hemoglobin A1C levels, total daily insulin dosage, body mass index (BMI), and body weight. However, the subgroup analysis demonstrated that HbA1c levels were not significantly changed in overweight/obese adolescents and were significantly reduced in the general patients. On the contrary, BMI and body weight were significantly reduced in overweight/obese adolescents but not in the general patients. Metformin was associated with higher incidence of adverse events. Conclusions. Among adolescents with T1DM, administering adjunctive metformin therapy in addition to insulin was associated with improved HbA1c levels, total daily insulin dosage, BMI, and body weight. However, there may be differences in the effects of this regimen between overweight/obese and nonobese adolescents. The risk of an adverse e Continue reading >>

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