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Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance

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Abstract

This study assessed the efficacy of adding metformin to a structured lifestyle intervention in reducing BMI in obese adolescents with insulin resistance. Obese adolescents (25) aged 10–16 years with a body mass index (BMI) > 95th percentile and insulin resistance (Homeostasis Model Assessment—HOMA) > 3.0 were assessed in a community clinic. A structured lifestyle intervention comprising nutritional and exercise education and motivational support in both individual and group sessions was delivered over 6 months. Subjects were randomized to lifestyle intervention alone or with metformin (1500 g daily). The primary outcome measures were a change in BMI and modification of metabolic risk factors, including insulin resistance, plasma lipids and adipocytokines. Eleven adolescents receiving lifestyle and metformin intervention and 14 receiving lifestyle alone completed the study. BMI decreased by 1.8 kg/m2 with lifestyle and metformin but did not change with lifestyle alone. HOMA was significantly decreased in the lifestyle intervention group, but not following metformin, while the adiponectin/leptin ratio improved significantly in both groups. Dyslipidemic profiles improved most significantly with metformin. We conclude that metformin in combination with a 6-month structured lifestyle intervention is effective in reducing BMI in obese adolescents but did not improve insulin resistance. Lifestyle intervention, with or without metformin, improved metabolic risk factors such as plasma lipids and adipocytokines.

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Acknowledgements

We are grateful to Lynda Bere, Bonnie Hill, Johanna Kaipainen and Ruth Aitchison for clinical and administrative support and Brenda Strutt who provided expert technical assistance. We acknowledge the financial support for this study provided by the Lawson Foundation, the Canadian Institutes of Health Research and the Lawson Health Research Institute.

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Authors and Affiliations

  1. Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, P.O. Box 5010, London, ON, N6A 5W9, Canada

    Cheril L. Clarson & Farid H. Mahmud

  2. Lawson Health Research Institute, London Health Sciences Centre, London, ON, N6A 5W9, Canada

    Cheril L. Clarson, Farid H. Mahmud & David J. Hill

  3. Department of Paediatrics, University of Western Ontario, London, ON, N6A 5A5, Canada

    Cheril L. Clarson, Farid H. Mahmud & David J. Hill

  4. Bluewater Diabetes and Clinical Nutrition Centre, Sarnia, ON, N7T 4S1, Canada

    Janet E. Baker, Helen E. Clark, Wendy M. Mckay & Vicki D. Schauteet

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  1. Cheril L. Clarson
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  2. Farid H. Mahmud
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  3. Janet E. Baker
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Correspondence to Cheril L. Clarson.

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The sponsors had no involvement in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

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Clarson, C.L., Mahmud, F.H., Baker, J.E. et al. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocr 36, 141–146 (2009). https://doi.org/10.1007/s12020-009-9196-9

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  • DOI: https://doi.org/10.1007/s12020-009-9196-9

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