TY - JOUR
T1 - Effect of metformin on vascular function in children with type 1 diabetes
T2 - A 12-month randomized controlled trial
AU - Anderson, Jemma J. A.
AU - Couper, Jennifer J.
AU - Giles, Lynne C.
AU - Leggett, Catherine E.
AU - Gent, Roger
AU - Coppin, Brian
AU - Peña, Alexia S.
PY - 2017/12
Y1 - 2017/12
N2 - Context: Children with type 1 diabetes have vascular dysfunction preceding atherosclerosis. Early interventions are needed to reduce cardiovascular disease.Objective: To evaluate the effect of metformin on vascular function in children with type 1 diabetes.Design: Twelve-month double-blind, randomized, placebo-controlled trial.Setting: Tertiary pediatric diabetes clinic.Participants: Ninety children (8 to 18 years of age), .50th percentile body mass index (BMI), with type 1 diabetes.Intervention: Metformin (up to 1 g twice a day) or placebo.Main Outcome Measure: Vascular function measured by brachial artery ultrasound [flow-mediated dilatation/glyceryl trinitrate-mediated dilatation (GTN)].Results: Ninety participants were enrolled [41 boys, 13.6 (2.5) years of age, 45 per group], 10 discontinued intervention, and 1 was lost to follow-up. On metformin, GTN improved, independent of glycosylated hemoglobin (HbA1c), by 3.3 percentage units [95% confidence interval (CI) 0.3, 6.3, P = 0.03] and insulin dose reduced by 0.2 U/kg/d (95% CI 0.1, 0.3, P = 0.001) during 12 months, with effects from 3 months.Metformin had a beneficial effect on HbA1c at 3 months (P = 0.001) and difference in adjusted HbA1c between groups during 12months was 1.0%; 95% CI 0.4, 1.5 (10.9mmol/mol; 95% CI 4.4, 16.4), P = 0.001. There were no effects on carotid/aortic intima media thickness, BMI, lipids, blood pressure, or other cardiovascular risk factors. Median (95% CI) adherence, evaluated by electronicmonitoring, was 75.5% (65.7, 81.5), without group differences.More gastrointestinal side effects were reported on metformin (incidence rate ratio 1.65, 95% CI 1.08, 2.52, P = 0.02), with no difference in hypoglycemia or diabetic ketoacidosis.Conclusions: Metformin improved vascular smooth muscle function and HbA1c, and lowered insulin dose in type 1 diabetes children. These benefits and good safety profile warrant further consideration of its use.
AB - Context: Children with type 1 diabetes have vascular dysfunction preceding atherosclerosis. Early interventions are needed to reduce cardiovascular disease.Objective: To evaluate the effect of metformin on vascular function in children with type 1 diabetes.Design: Twelve-month double-blind, randomized, placebo-controlled trial.Setting: Tertiary pediatric diabetes clinic.Participants: Ninety children (8 to 18 years of age), .50th percentile body mass index (BMI), with type 1 diabetes.Intervention: Metformin (up to 1 g twice a day) or placebo.Main Outcome Measure: Vascular function measured by brachial artery ultrasound [flow-mediated dilatation/glyceryl trinitrate-mediated dilatation (GTN)].Results: Ninety participants were enrolled [41 boys, 13.6 (2.5) years of age, 45 per group], 10 discontinued intervention, and 1 was lost to follow-up. On metformin, GTN improved, independent of glycosylated hemoglobin (HbA1c), by 3.3 percentage units [95% confidence interval (CI) 0.3, 6.3, P = 0.03] and insulin dose reduced by 0.2 U/kg/d (95% CI 0.1, 0.3, P = 0.001) during 12 months, with effects from 3 months.Metformin had a beneficial effect on HbA1c at 3 months (P = 0.001) and difference in adjusted HbA1c between groups during 12months was 1.0%; 95% CI 0.4, 1.5 (10.9mmol/mol; 95% CI 4.4, 16.4), P = 0.001. There were no effects on carotid/aortic intima media thickness, BMI, lipids, blood pressure, or other cardiovascular risk factors. Median (95% CI) adherence, evaluated by electronicmonitoring, was 75.5% (65.7, 81.5), without group differences.More gastrointestinal side effects were reported on metformin (incidence rate ratio 1.65, 95% CI 1.08, 2.52, P = 0.02), with no difference in hypoglycemia or diabetic ketoacidosis.Conclusions: Metformin improved vascular smooth muscle function and HbA1c, and lowered insulin dose in type 1 diabetes children. These benefits and good safety profile warrant further consideration of its use.
KW - Diabetes
KW - Pancreatic
KW - Hormones
KW - Gastrointestinal
UR - http://www.scopus.com/inward/record.url?scp=85038257514&partnerID=8YFLogxK
U2 - 10.1210/jc.2017-00781
DO - 10.1210/jc.2017-00781
M3 - Article
C2 - 29040598
AN - SCOPUS:85038257514
SN - 0021-972X
VL - 102
SP - 4448
EP - 4456
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 12
ER -
