Nwosu, Benjamin U.Maranda, LouiseCullen, KarenGreenman, LisaFleshman, JodyMcShea, NancyBarton, Bruce ALee, Mary M.2022-08-232022-08-232015-09-142015-09-16<p>Nwosu BU, Maranda L, Cullen K, Greenman L, Fleshman J, McShea N, Barton BA, Lee MM. A Randomized, Double-Blind, Placebo-Controlled Trial of Adjunctive Metformin Therapy in Overweight/Obese Youth with Type 1 Diabetes. PLoS One. 2015 Sep 14;10(9):e0137525. doi: 10.1371/journal.pone.0137525. eCollection 2015. PubMed PMID: 26367281. <a href="http://dx.doi.org/10.1371/journal.pone.0137525" target="_blank">Link to article on publisher's website</a></p>1932-620310.1371/journal.pone.013752526367281https://hdl.handle.net/20.500.14038/43230<p>Data Availability: Our study data files are publicly deposited in the University of Massachusetts Medical School’s institutional repository, <a href="http://escholarship.umassmed.edu" target="_blank" title="eScholarship@UMMS">eScholarship@UMMS</a>. The permanent links to the data are: <a href="http://dx.doi.org/10.13028/M2RP4C">http://dx.doi.org/10.13028/M2RP4C</a> or <a href="http://escholarship.umassmed.edu/pediatrics_data/2/">http://escholarship.umassmed.edu/pediatrics_data/2/</a>.</p>CONTEXT: Insulin resistance has been proposed as one of the causes of poor glycemic control in overweight/obese youth with type 1 diabetes (T1D). However, the role of adjunctive metformin, an insulin sensitizer, on glycemic control in these patients is unclear. OBJECTIVE: To compare the effect of metformin vs. placebo on hemoglobin A1c (HbA1c), total daily dose (TDD) of insulin, and other parameters in overweight/obese youth with T1D. HYPOTHESIS: Adjunctive metformin therapy will improve glycemic control in overweight/obese youth with T1D. DESIGN, SETTING, AND PARTICIPANTS: A 9-mo randomized, double-blind, placebo controlled trial of metformin and placebo in 28 subjects (13m/15f) of ages 10-20years (y), with HbA1c >8% (64 mmol/mol), BMI >85%, and T1D > 12 months was conducted at a university outpatient facility. The metformin group consisted of 15 subjects (8 m/ 7f), of age 15.0 ± 2.5 y; while the control group was made up of 13 subjects (5m/ 8f), of age 14.5 ± 3.1y. All participants employed a self-directed treat-to-target insulin regimen based on a titration algorithm of (-2)-0-(+2) units to adjust their long-acting insulin dose every 3rd day from -3 mo through +9 mo to maintain fasting plasma glucose (FPG) between 90-120 mg/dL (5.0-6.7 mmol/L). Pubertal maturation was determined by Tanner stage. RESULTS: Over the course of the 9 months of observation, the between-treatment differences in HbA1c of 0.4% (9.85% [8.82 to 10.88] for placebo versus 9.46% [8.47 to 10.46] for metformin) was not significant (p = 0.903). There were non-significant reduction in fasting plasma glucose (189.4 mg/dL [133.2 to 245.6] for placebo versus 170.5 mg/dL [114.3 to 226.7] for metformin), (p = 0.927); total daily dose (TDD) of short-acting insulin per kg body weight/day(p = 0.936); and the TDD of long-acting insulin per kg body weight per day (1.15 units/kg/day [0.89 to 1.41] for placebo versus 0.90 units/kg/day [0.64 to 1.16] for metformin) (p = 0.221). There was no difference in the occurrence of hypoglycemia between the groups. CONCLUSIONS: This 9-month RCT of adjunctive metformin therapy in overweight and obese youth with T1D resulted in a 0.4% lower HbA1c value in the metformin group compared to the placebo group. TRIAL REGISTRATION: ClinicalTrial.gov NCT01334125.en-US<p>Copyright: © 2015 Nwosu et al. This is an open access article distributed under the terms of the <a href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</p>http://creativecommons.org/licenses/by/4.0/UMCCTS fundingtype 1 diabetes mellitusbiguanidesmetformininsulin resistanceEndocrine System DiseasesEndocrinology, Diabetes, and MetabolismPediatricsJournal Articlehttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1053&amp;context=peds_endocrinology&amp;unstamped=1https://escholarship.umassmed.edu/peds_endocrinology/547604754peds_endocrinology/54