Metformin a diabetes prevention tool for young adults

Pamela Egan Practical Practitioner

 

By: Pamela Egan, FNP-C CDE

 

 

Metformin a prevention tool for young adults

 

 

Dear Pam,

My 15-year-old daughter is overweight and her blood work shows hyperglycemia, but not yet Diabetes. There is diabetes on both sides of our family. Is there any way to prevent diabetes in her case?

The dramatic increase in the number of adolescents and young adults with Type 2 Diabetes is strongly linked to the rise in pediatric obesity. Lifestyle and diet modifications are essential in the prevention of type 2 diabetes in obese adolescents, but new data show that the medication metformin (also known as Glucophage), may be a useful adjunct.

Diet and exercise represent the foundation of care for all obese individuals. Unfortunately the long-term success of lifestyle intervention alone has been disappointing. This has stimulated interest in potential pharmacological approaches to diabetes prevention.

Allow your daughter to join a gym and hire a personal trainer for her if possible to get her on the right track.

Don’t buy high density carbohydrates containing sugar or white flour (such as white rice, pasta, white potatoes, white bread, sweets). Don’t keep them in your house. Low density carbs such as fruit and vegetables are a better choice, but in moderation. Encourage her to sign up for a nutrition class.

Metformin is generally well tolerated and causes little or no weight gain. Previous studies in adults showed that metformin decreases liver glucose uptake and may reduce food intake and body fat mass. Among trial patients receiving metformin, fasting blood glucose levels decreased, while increasing in the placebo group (those given sugar pills).

The rates of Type 2 Diabetes continue to increase despite widespread recognition of the dangers of poor diet and a sedentary existence.

Metformin may be useful in preventing glucose intolerance in obese adolescents.

The drug is generally well tolerated and causes little or no weight gain.

Michael Freemark, MD, professor of pediatric endocrinology at Duke University Medical Center, and his colleagues randomized 29 obese adolescents to receive placebo or metformin for six months. Participants had a BMI (Body Mass Index) of 38.7-41.5kg/m2, fasting hyperinsulinemia (too much insulin in the blood) and a family history of type 2 diabetes. A BMI of 27 or above is considered overweight.

Fasting blood glucose levels declined in the metformin group and rose in the placebo group. There was also a reduction in fasting insulin concentrations in the metformin group that was not seen in the placebo group.

The effect on BMI also differed between the two groups. Adolescents in the metformin group had an average decrease of 1.3 percent from baseline while those in the placebo group had an average increase of 2.3 percent from baseline. Interestingly, metformin is used in Europe for weight loss.

Freemark noted that the effects of metformin in non-diabetic adolescents have been confirmed. In one study, metformin combined with a low-calorie diet decreased body fat, plasma leptin levels, plasma insulin concentrations, and plasma cholesterol and triglyceride levels, when compared with placebo. Insulin sensitivity increased with metformin.

In the Diabetes Prevention Program, metformin reduced the incidence of type 2 diabetes in adults with impaired glucose tolerance. The drug was most effective in the youngest patients with highest BMI.

This article was originally published April 28, 2003 in The St. Tammany News.


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