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Masarwa R, Brunetti VC, Aloe S, et al. Efficacy and Safety of Metformin for Obesity: A Systematic Review. Pediatrics. 2021 Mar;147(3). pii: peds.2020-1610. doi: 10.1542/peds.2020-1610. (Systematic review)
Abstract

CONTEXT: The efficacy and safety of metformin for obesity in children and adolescents remains unclear.

OBJECTIVE: To assess the efficacy and safety of metformin via systematic review.

DATA SOURCES: Data sources included PubMed, Embase, the Cochrane Library, Scopus, and ClincalTrials.gov (inception to November 2019).

STUDY SELECTION: We selected randomized controlled trials (RCTs) in which researchers assessed the efficacy and safety of metformin with lifestyle interventions, compared with a placebo with lifestyle interventions, in children and adolescents with obesity.

DATA EXTRACTION: Two researchers independently extracted data and assessed quality. The primary outcomes were mean changes from baseline in BMI, BMI z score, homeostatic model assessment of insulin resistance, and gastrointestinal adverse effects.

RESULTS: Twenty-four RCTs (1623 patients; range: 16 to 151) were included. Ages ranged from 4 to 19 years, and follow-up ranged from 2 months to 2 years. Metformin resulted in a modest decrease in BMI (range of mean values: -2.70 to 1.30 vs -1.12 to 1.90), BMI z score (range of mean values: -0.37 to -0.03 vs -0.22 to 0.15), and homeostatic model assessment of insulin resistance (range of mean values: -3.74 to 1.00 vs -1.40 to 2.66). Metformin resulted in a higher frequency of gastrointestinal adverse effects (range: 2% to 74% vs 0% to 42%).

LIMITATIONS: The available evidence is of varying quality, with high heterogeneity between trials, suggesting some uncertainty in the benefits of metformin in this population.

CONCLUSIONS: With this systematic review of RCTs, we suggest that metformin has modest but favorable effects on weight and insulin resistance and a tolerable safety profile among children and adolescents with obesity.

Ratings
Discipline Area Score
Physician 6 / 7
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Comments from MORE raters

Physician rater

At best, several small, heterogeneous studies of children and adolescents suggest metformin might help a little. Tolerability might be an issue. Some studies had high drop out rates, which does not bode well for our less motivated and compliant non-study populations.

Physician rater

I thought metformine had better evidence improving BMI in underaged population than this review shows. One thing called my attention: if the review was performed in Canada, why was the study selection performed at Qatar?
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