Endocrine Abstracts

JOINT623

Background: Pediatric obesity is a growing global health challenge, often linked to metabolic complications such as insulin resistance and type 2 diabetes mellitus (T2DM). Metformin, a staple medication for T2DM, has gained attention for its potential to manage obesity and associated cardiometabolic risks in children and adolescents. This review evaluates evidence from 19 studies to assess metformin’s efficacy and safety in addressing pediatric obesity.

Methods: A total of 19 studies were analyzed, including 10 randomized controlled trials (RCTs) involving 657 patients, an open-label extension study with 42 participants, a retrospective review of 78 patients, a meta-analysis, and 5 narrative reviews. The studies spanned from 2008 to 2024 and investigated metformin’s effects on body mass index (BMI), insulin sensitivity, and other metabolic parameters in obese pediatric populations.

Results: Efficacy:.

• Across the studies, metformin consistently reduced BMI and improved insulin sensitivity, with high-quality RCTs demonstrating significant metabolic benefits, particularly in prepubertal children and those with insulin resistance.

• Studies such as Yanovski et al. (2011) and Pastor-Villaescusa et al. (2017) reported modest yet meaningful BMI reductions and enhancements of metabolic markers.

• Observational studies and systematic reviews supported these findings, reinforcing metformin’s role as a cost-effective intervention for managing pediatric obesity.

• The strongest benefits were observed in patients with baseline insulin resistance, with consistent improvements in BMI Z-scores, fasting insulin levels, and body composition.

Safety:.

• Metformin displayed a favorable safety profile across all studies. Common side effects, including mild gastrointestinal discomfort, were transient and self-limiting.

• No serious adverse events were reported, even in long-term studies.

Patient Impact:.

• The review included 777 patients across various study types. Prepubertal children and those with insulin resistance exhibited the most substantial benefits, with improved BMI Z-scores, metabolic health, and body composition.

Conclusions: Metformin is a safe and effective intervention for managing pediatric obesity, particularly for patients with insulin resistance. Robust evidence supports its use in reducing BMI and improving metabolic health, with the greatest benefits observed in prepubertal children. While its long-term effects require further investigation, current evidence positions metformin as a valuable tool for combating pediatric obesity and its cardiometabolic complications.

Keywords: Metformin, Pediatric Obesity, Insulin Resistance, Cardiometabolic Health, Randomized Controlled Trials.