Abstract
The purpose of this study was to analyze the time course and dose effect from metformin on body mass index (BMI) in children and adolescents by model-based meta-analysis (MBMA). Searching randomized controlled trial (RCT) studies of metformin on BMI in children and adolescents. The change rates of BMI from baseline values were used as indicator of evaluating metformin efficacy. A total of 18 RCT studies, 1,228 children and adolescents, were included for analysis, including patients with obesity, patients with type 1 diabetes mellitus, patients with nonalcoholic fatty liver, and patients with precocity. In order to achieve better effect of metformin on BMI in children and adolescents, the present study recommended that for patients with obesity, 1,000 mg/day metformin was required for at least 15.2 weeks and 60.8 weeks to achieve the plateau of metformin effect; for patients with type 1 diabetes mellitus, 1,000 mg/day metformin was required for at least 25.2 weeks and 100.8 weeks to achieve the plateau of metformin effect; for patients with nonalcoholic fatty liver, 1,000 mg/day metformin was required for at least 6.57 weeks and 26.28 weeks to achieve the plateau of metformin effect; for patients with precocity, 425 mg/day metformin was required for at least 12.4 weeks and 49.6 weeks to achieve the plateau of metformin effect. It was the first time to analyze the time course and dose effect from metformin on BMI and to recommend dosage and duration of treatment for metformin in children and adolescents with different disease types.
Highlights
Metformin was widely used in the control of weight in different diseases of children and adolescents (Kendall et al, 2013; Pastor-Villaescusa et al, 2017)
In the included studies, the dosage ranges of metformin in patients with obesity were 1,000 mg/day–2,000 mg/day, in patients with type 1 diabetes mellitus were 1,000 mg/day–1,700 mg/day, in patients with nonalcoholic fatty liver were 1,000 mg/day–1,700 mg/day, and in patients with precocity were 425 mg/day–850 mg/day, respectively
In patients with type 1 diabetes mellitus, the efficacy of metformin on body mass index (BMI) at 8.4 weeks was 25% of the Emax, at 25.2 weeks was 50% of the Emax, at 75.6 weeks was 75% of the Emax, and at 100.8 weeks was 80% of the Emax
Summary
Metformin was widely used in the control of weight in different diseases of children and adolescents (Kendall et al, 2013; Pastor-Villaescusa et al, 2017). Metformin controlled weight mainly through decreasing caloric intake, including direct and indirect impacts on appetite regulation from the gastrointestinal side effects (Yerevanian and Soukas, 2019). Metformin on BMI in Children and Adolescents circulating levels, lowering food intake and reducing body weight by means of the brain-stem–restricted receptor (Coll et al, 2020). The weight control of patients with metformin was offlabel, lacking clinical dosage and duration of treatment recommendation. The time course and dose effect of metformin on body mass index (BMI) in children and adolescents with different disease types were unclear
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