In the name of god

Shiraz E-Medical Journal
Vol. 12, No. 4, October 2011
Benefits of Metformin Combined with Insulin in Children with Type
1 Diabetes Mellitus.
Abdeyazdan Z *, Hashemipour M**, Barekatain R***, Kalantary F±, Amini MΩ. * Associate Professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, ** Professor, Department of Pediatrics, School of Medicine, *** Pediatrician, Endocrine and Metabolism Research Center, ± Nurse, Endocrine and Metabolism Research Center, Ω Professor, Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Correspondence: Dr. Zahra Abdeyazdan, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Hezarjerib Ave, Isfahan, Iran, Telephone: +98(311)7922-908, E Received for Publication: August 10, 2010, Accepted for Publication: August 28, 2011.
Background: Some patients with type 1 diabetes mellitus have not good glycaemic control with ordinary doses of insulin. So applying other treatment modality in addition to insulin and diet therapy could improve glycaemic control. Objective: To evaluate whether, in patients with type 1 diabetes mellitus, the addition of Metformin to insulin and standard diabetes management result in better glycaemic control and lower insulin dosage . Methods: In a clinical trial study 16 children and adolescents with type 1 diabetes with had high insulin intake and HbA1c >8% were participated. HbA1c, FBS, 2hpp BG, insulin dosage and BMI were measured and compared at the onset and end of the treatment. Results: There were significant differences in HbA1c and insulin dosage between the time of 0 of the study and after 4 months of Metformin addition therapy. But there were no significant differences between BMI, FBG and 2 h pp BG at the onset of the study and end of it. Conclusion: Metformin treatment lowered HbA1c and decreased insulin dosage in patients with type 1 diabetes in poor metabolic control. Long term studies will determine if these improvements are sustained. Keywords: Type 1 diabetes mellitus, Metformin, HbA1c, Fasting, Blood Sugar
positive effect of metformin in these pa- On the convenient feature, until now this Ninety percent of diabetic patients will So the purpose of this study was first to determine if the addition of metformin to regular diabetes care in type 1 diabetic patients would improve glycaemic control as assess by clinical outcomes of lowered vival.(3) Until now treatment with insulin Methods and subjects:
ter glycaemic control in type 1 diabetic Study design:
This was a clinical trial of 4 months dura- Insulin is an appetite stimulant particu- pediatric clinic of diabetes in Endocrine and Metabolism Research center affiliated insulin is associated with weight gain and to Isfahan University of Medical Sciences. obesity is associated with insulin resis- tance (5) followed by increase of the insu- written informed permission before entry lin doses necessary to improve blood glu- Subjects & Sample size:
used in treatment of patients with type 2 acts by diminishing basal hepatic glucose production and increasing glucose uptake bined with insulin in patients with type 1 diabetes. These studies have suggested a inclusion and exclusion criteria:
To minimize GI side effects, the drug was injection of insulin NPH plus insulin Regu- Patients were requested to visit the doc- tor every month. At each visit they were Further inclusion criteria included poor evaluated for metabolic control, protocol higher) in the previous year, fasting se- poglyceamic episodes and GI side effects rum C Peptide <0.18 nmol/lit after injec- of metformin. Hepatic and renal function tion of Glucagons, History of diagnosis of cidosis, and duration of diabetes for at awareness hypoglyceamia, clinical or bio- ferences in the subjects before and after treatment. P value<0.05 was considered interpretation of the results difficult. Study protocol and treatment:
mate capillary blood glucose using owns' ter, at laboratory of the Clinic. They were asked to check blood glucose at fasting, 2hpp and before evening insulin injection lycemia and to call the doctor, if needed patients/parents or the doctor via phone men of insulin therapy as previously (as During the study, there were no episodes metformin because of unpleasant taste of (before evening insulin injection ) at the Mean of HbA1C, at the time of 0 of study trospectively), however this indicator was end of study it was 8.3±1.2. Paired t test 195±43 mg/dl at the beginning the study progression, and at the end of the study it was significantly less than the time of 0 Also there was not significant difference end of study (20.39±2.7, and 20.42±2.7 Table 1, Comparison of glyceamic control and metabolic indictors before and after the intervention At the time of
At the end of
0 of study
tion of weight in patients with type 1 di- in diabetic children with badly glycaemic insulin.(7) Our results were inconsistent with their study; explanation is probably due to short period of the present study. result in significant improvement of gly- accompanied with reduction of total daily ings of previous studies.(2, 3, and 7) Tatsu- References:
our patients as their blood glucoses were 1. Goldman , Ausiello .Cecil Medicine.23rd 2. Vaag A, luad S. Effect of metformin in patients with type 1 Diabetes mellitus with inadequate Glycemic control by insulin and diet. National Institate of health.Available Gov/ct/show/Nct 00118237 (updated 2005). their previous drug regimen, this causes 3. A.S.A.Khan,C.R. Mcloughney ,A.B. Ahmed some limitation for the present study e.g. . The effects of metformin on blood glucose control in overweight patients with type 1 4. Z.Abdeyazdan, N. Sadeghi, B.Forghani, et al. Comparison of dietary intake between children with diabetes mellitus and control group.Iranian journal of diabetes and Lipid 5. E. Gunton and S.M. Twigg. Metformin use as an adjunct to Insulin treatment in se- lected patients with type 1 diabetes mellitus. clinical trials with larger sample sizes and Ph.Lehert, N .Cugnardey, P. Drouin,B Guerci .The Benefits of Metformin therapy during will copy with this modality of treatment. treatment of type 1 diabetec patients. Di- Acknowlodgments:
7. T. Urakami, Sh. Morimoto, M. Owada and K. Harada. Usefulness of the addition of metformin to Insulin in pediatric patientis with type 1 diabetes mellitus. Pediatrics affiliated to Isfahan University of Medical tance in data analyses, also our patients Insulin in type 1 diabetes. Diabetes care Copyright 2011, Shiraz E Medical Journal. All rights reserved.


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