Metformin: new indication. Useful for some children with type 2 diabetes.

(1) Type 2 diabetes is rare in children. Lifestyle measures are the cornerstone of treatment. When they fail to control hyperglycaemia and when drug therapy is envisaged, insulin has long been the only approved drug. (2) Metformin is now indicated to treat hyperglycaemia due to type 2 diabetes in children over 10 years of age, alone or in combination with insulin. (3) In a randomised double-blind placebo-controlled trial involving 82 children, the mean reduction in HbA1c level with metformin was statistically significant after 8 weeks of treatment (about 1% in absolute values, versus no change in the placebo group). (4) In a randomised unblinded trial the addition of metformin to ongoing insulin therapy in 106 children reduced both mean HbA1c levels and weight gain after one year of treatment. About one-third of children treated with metformin were able to stop using insulin and maintain satisfactory glycaemic control. (5) The adverse effects of metformin in children are the same as those reported in adults (mainly frequent but mild gastrointestinal disorders). (6) Metformin is taken orally, making it more convenient to use than insulin, especially in long-term treatment. (7) In practice, although the assessment of metformin in children with type 2 diabetes is limited, metformin is a useful oral addition or alternative to insulin injection. Metformin addition to ongoing insulin therapy allows some patients to stop using insulin altogether.

RCT Entities:   Population Interventions Outcomes