Metformin: use as a pharmacological agent in management of childhood obesity

Abstract

INTRODUCTION: Childhood obesity-related metabolic derangements are increasing among South Asian populations. Dietary and physical activity plans have limited effect. OBJECTIVES: This study aims to assess effectiveness of metformin against placebo in management of childhood obesity among 8-16 year-old children in Gampaha District. METHOD: A triple-blinded control trial was conducted in a sample of 150 obese school children. After 12-hour overnight fast, blood was drawn for fasting blood glucose (FBS) and lipid profile. 2-hour OGTT was done. Anthropometry, fat mass (FM) and blood pressure were measured. Children randomly received either age-adjusted dose of metformin or placebo, with advice on diet and physical activity. Anthropometry and blood investigations were repeated at 6 and 12 months. Mean difference in outcome measures, adjusted for baseline values were compared between the two groups using ANOVA. RESULTS: There were 84/150 boys and 25 (16.7%) had metabolic syndrome. A statistically significant adjusted mean reduction was observed in metformin group compared to placebo, in weight (-0.991 vs 1.394, p=0.000), BMI-SDS (-0.287 vs -0.116, p=0.000), percentage FM-SDS (-0.092 vs 0.016, p=0.04), systolic BP (-0.415 vs 0.015, p=0.015), total cholesterol (-36.48 vs -27.32, p=0.001), LDL (-26.06 vs -17.22, p=0.001) and hsCRP(-0.143 vs 0.008, p=0.013) at six months, and in BMI-SDS (-370 vs -0.222, p=0.001), WC-SDS (-0.473 vs -0.337, p=0.018), systolic BP (-0.834 vs -0.477, p=0.023) and triglycerides (-29.30 vs-12,72, p=0.019) at 12 months. CONCLUSIONS: Metformin compared to placebo has beneficial effects on anthropometric and metabolic indicators in the management of childhood obesity.