| Objective :To investigate the effect of metformin on children with hyperinsulinemia and without diabetes.Methods:By selecting 82 cases of obese children aged 8-16 years old in the General Hospital of Tianjin Medical University from January 2015 to December 2016,all of them were diagnosed with hyperinsulinemia and without type 2 diabetes mellitus diagnosis or additional medical problems,18 cases of children with impaired glucose tolerance(IGT).A total of 82 cases including 24 girls and with a mean age of 11.8±1.83 years,all cases were treated with 500 mg metformin bid or tid in addition to lifestyle change for one year.Lifestyle change included individually tailored exercise and dietary lifestyle interventions.Clinical anthropometric [height,weight,body mass index(BMI),waist circumference(WC),hip circumference,waist to hip ratio(WHR)waist-height ratio(WHtR)] were measured at the beginning of treatment,3 months,6 months,and 12 months;blood biochemical indexes [glucose and insulin secretion after a glucose load,alanine aminotransferase(ALT),aspartate aminotransferase(AST)etc] and index of islet function(insulin resistance index,whole body insulin sensitivity index,function of pancreatic beta-cell,first-phase insulin secretion index and area under curve of insulin)were compared at the beginning of treatment,6 months,and 12 months.Monitor gastrointestinal reaction and other adverse reactions and timely adjust the drug dose.Results:1.The mean BMI value measured at the beginning was 30.81±4.49kg/m2 and was found to have regressed to 27.00±4.21 kg/m2 at the end of the treatment;WC and WHR decreased compared with the initial,but there was no significant difference between 3,6,and 12 months;compared with the initial,WHtR decreased,the difference was statistically significant(P<0.05),but there was no significant difference between 6 and 12 months.2.When treated with metformin and lifestyle intervention for half year,insulin levels decreased significantly at each time point,compared with 6 months,the level of fasting insulin and the insulin in 1 hour,2 hour after a glucose load kept decreasing(all P<0.05),and the glucose level in 2 hours after a glucose load was decreased(7.06±1.66 to 6.52±1.40mmol/L)(all P<0.05).3.After 6 months of metformin treatment,insulin resistance index,function of pancreatic beta-cell and area under curve of insulin were all decreased whereas whole body insulin sensitivity index increased(all P<0.05),insulin resistance index continued to decline,whole body insulin sensitivity index continued to rise at 12 months(P<0.05),no statistical difference of first-phase insulin secretion index was observed and acanthosis nigricans was improved in varying degrees.4.After treatment with metformin and life intervention for one year,13 out of 18 children with impaired glucose tolerance returned to normal glucose level and the other 5 children had different degrees of reduction,and the blood glucose was significantly reduced after treatment(P<0.05).5.On the basis of reduced weight and improved insulin sensitivity,after treatment,ALT and AST decreased(P<0.05).6.All of the children who received metformin treatment only had diarrhea,abdominal discomfort and other gastrointestinal symptoms,but they can tolerate through adjustment,no rash,hypoglycemia,anemia and other serious adverse reactions occurred.Conclusions:1.When combined with life intervention,metformin reduces BMI in children and adolescents with hyperinsulinemia.2.Metformin may be useful as an additional therapy in combination with lifestyle intervention in improving insulin sensitivity and relieving insulin resistance.3.Metformin could induce patients with impaired glucose tolerance to normal glucose tolerance,delayed the development of impaired glucose tolerance to type 2 diabetes,and improve glucose metabolism in obese pre-diabetes children.4.Metformin also had a certain effect on improving liver enzymes.5.Metformin was safe,effective and well tolerated in the treatment of obese children with hyperinsulinemia. |
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