Treatment of clinical insulin resistance in children: a systematic review
| Autor: | Louise A. Baur, Sarah P. Garnett, Christopher T. Cowell, S. M. Quinn |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
education.field_of_study
medicine.medical_specialty business.industry Endocrinology Diabetes and Metabolism Insulin medicine.medical_treatment Population Public Health Environmental and Occupational Health medicine.disease Placebo Confidence interval Metformin Surgery law.invention Insulin resistance Randomized controlled trial law Internal medicine Medicine business education Body mass index medicine.drug |
| Zdroj: | Obesity Reviews. 11:722-730 |
| ISSN: | 1467-7881 |
| DOI: | 10.1111/j.1467-789x.2009.00697.x |
| Popis: | The objective of this study was to evaluate the effectiveness of interventions aimed at improving clinical insulin resistance and/or pre-diabetes in children. This study is a systematic review and meta-analysis. Five electronic databases were searched for randomized controlled trials of at least 2-months' duration. The outcomes were fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI) and adverse outcomes. Four randomized controlled trials were identified. All compared the effect of 6 months of metformin plus or minus lifestyle intervention with placebo plus or minus lifestyle intervention. After pooling results from three trials, the mean difference after 6 months favoured the intervention with a statistically significant mean decrease in fasting insulin, HOMA-IR and BMI of 9.6 µU mL(-1) (95% confidence interval [CI]: 6.3, 13.0 µU mL(-1) ; I(2) = 76%), 2.7 (95% CI: 1.7, 3.6; I(2) = 74%) and 1.7 kg m(-2) (95% CI: 1.1, 2.3 kg m(-2) ; I(2) = 75) respectively. Mild gastrointestinal symptoms were reported in 19% (2-29%; median and range) of participants taking metformin. Metformin improves markers of insulin sensitivity and reduces BMI in children and adolescents with clinical insulin resistance or pre-diabetes. Stronger evidence from high-quality studies of longer duration and larger sample size are required before clinical conclusions about the optimal treatment protocol in this population can be drawn. |
| Databáze: | OpenAIRE |
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