Endocrine Abstracts

JOINT778

Background: Obesity in children and adolescents is a global health challenge linked to metabolic and cardiovascular complications. Metformin, a drug primarily used for type 2 diabetes, has gained attention for its potential benefits in managing obesity-related cardiometabolic risks. This review synthesizes evidence on metformin’s short- and long-term effects, including its impact on BMI, insulin sensitivity, inflammation, lipid profiles, and cardiovascular risk markers.

Methods: This review included 19 studies, comprising 10 randomized controlled trials (RCTs), observational studies, systematic reviews, and meta-analyses. Collectively, these studies evaluated 777 patients, with a focus on obese children and adolescents. Key outcomes examined included BMI changes, insulin sensitivity, inflammatory markers, lipid profiles, and vascular health indicators.

Results: This review analyzed 19 studies, including 10 randomized controlled trials (RCTs) with 657 patients, alongside observational studies, systematic reviews, and meta-analyses, encompassing a total of 777 patients. High-quality RCTs, such as those by Yanovski et al. (2011), Pastor-Villaescusa et al. (2017), and Masarwa et al. (2021), demonstrated metformin’s consistent efficacy in reducing BMI and improving insulin sensitivity. Short-term studies showed significant improvements, including a 3-5% reduction in BMI, 15-20% improvement in insulin sensitivity (HOMA-IR scores), and 10-15% reduction in pro-inflammatory markers. Lipid profile improvements included 5-8% enhancement in HDL and triglyceride ratios, and cardiovascular markers, such as carotid intimal-medial thickness (CIMT) and blood pressure, showed modest improvements of approximately 5%. Long-term impacts, while less pronounced, included sustained effects such as a 2-3% reduction in BMI, 5-10% improvement in insulin sensitivity, and 2-5% improvements in lipid profiles. Notably, cardiovascular markers, such as CIMT and blood pressure, demonstrated ~10% sustained improvement over time. While inflammation data were limited in long-term studies, a sustained effect of ~5% reduction in pro-inflammatory markers was suggested. The findings highlight metformin’s robust short-term effects in managing obesity-related metabolic risks, with evidence supporting its use in insulin-resistant and prepubertal populations. Across all studies, metformin demonstrated a favorable safety profile with no serious adverse events, making it a cost-effective and valuable intervention for pediatric obesity.

Conclusions: Metformin is a safe and effective intervention for short-term management of pediatric obesity and its cardiometabolic risks. Evidence supports its ability to modestly reduce BMI, improve insulin sensitivity, and address key cardiovascular risk factors. Long-term benefits, particularly in preventing cardiovascular events, require further research. Its consistent safety and cost-effectiveness make metformin a valuable therapeutic option for managing obesity-related metabolic challenges in children and adolescents.