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- Title
Treatment of clinical insulin resistance in children: a systematic review.
- Authors
Quinn, S. M.; Baur, L. A.; Garnett, S. P.; Cowell, C. T.
- Abstract
The objective of this study was to evaluate the effectiveness of interventions aimed at improving clinical insulin resistance and/or pre-diabetes in children. This study is a systematic review and meta-analysis. Five electronic databases were searched for randomized controlled trials of at least 2-months' duration. The outcomes were fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI) and adverse outcomes. Four randomized controlled trials were identified. All compared the effect of 6 months of metformin plus or minus lifestyle intervention with placebo plus or minus lifestyle intervention. After pooling results from three trials, the mean difference after 6 months favoured the intervention with a statistically significant mean decrease in fasting insulin, HOMA-IR and BMI of 9.6 µU mL−1 (95% confidence interval [CI]: 6.3, 13.0 µU mL−1; I2 = 76%), 2.7 (95% CI: 1.7, 3.6; I2 = 74%) and 1.7 kg m−2 (95% CI: 1.1, 2.3 kg m−2; I2 = 75) respectively. Mild gastrointestinal symptoms were reported in 19% (2-29%; median and range) of participants taking metformin. Metformin improves markers of insulin sensitivity and reduces BMI in children and adolescents with clinical insulin resistance or pre-diabetes. Stronger evidence from high-quality studies of longer duration and larger sample size are required before clinical conclusions about the optimal treatment protocol in this population can be drawn.
- Subjects
INSULIN therapy; DIABETES in children; INSULIN pumps; TREATMENT of diabetes; META-analysis; METFORMIN
- Publication
Obesity Reviews, 2010, Vol 11, Issue 10, p722
- ISSN
1467-7881
- Publication type
Article
- DOI
10.1111/j.1467-789X.2009.00697.x