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Treatment of clinical insulin resistance in children: a systematic review

S M Quinn1, L A Baur, S P Garnett

  • 1Graduate Medical Program, University of Sydney, Australia.

Obesity Reviews : an Official Journal of the International Association for the Study of Obesity
|December 17, 2009
PubMed

Insights

Metformin effectively improves insulin resistance and reduces BMI in children with pre-diabetes. This systematic review found significant benefits but calls for more high-quality research on optimal treatment protocols.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Evidence-Based Medicine

Background:

  • Insulin resistance and pre-diabetes are growing concerns in pediatric populations.
  • Effective interventions are needed to manage these conditions and prevent progression to type 2 diabetes.

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness of interventions for improving clinical insulin resistance and pre-diabetes in children.
  • To evaluate the impact on fasting insulin, HOMA-IR, and BMI.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) with a minimum 2-month duration.
  • Searched five electronic databases for relevant studies.
  • Pooled data from four identified RCTs comparing metformin with placebo, with or without lifestyle interventions.

Main Results:

  • Metformin significantly decreased fasting insulin by 9.6 µU/mL, HOMA-IR by 2.7, and BMI by 1.7 kg/m² after 6 months.
  • Mild gastrointestinal symptoms were the most common adverse event associated with metformin (19% median incidence).

Conclusions:

  • Metformin demonstrates efficacy in improving insulin sensitivity markers and reducing BMI in pediatric patients with insulin resistance or pre-diabetes.
  • Further high-quality, longer-duration studies with larger sample sizes are necessary to establish definitive clinical treatment guidelines.

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