Shiraz E-Medical Journal Vol. 12, No. 4, October 2011 http://semj.sums.ac.ir/vol12/apr2011/89032.htm Benefits of Metformin Combined with Insulin in Children with Type 1 Diabetes Mellitus.
Abdeyazdan Z *, Hashemipour M**, Barekatain R***, Kalantary F±, Amini MΩ. * Associate Professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, ** Professor, Department of Pediatrics, School of Medicine, *** Pediatrician, Endocrine and Metabolism Research Center, ± Nurse, Endocrine and Metabolism Research Center, Ω Professor, Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Correspondence: Dr. Zahra Abdeyazdan, Nursing and Midwifery Care Research Center, Faculty of
Nursing and Midwifery, Hezarjerib Ave, Isfahan, Iran, Telephone: +98(311)7922-908, E
Received for Publication: August 10, 2010, Accepted for Publication: August 28, 2011. Abstract:
Background: Some patients with type 1 diabetes mellitus have not good glycaemic control with ordinary doses of insulin. So applying other treatment modality in addition to insulin and diet therapy could improve glycaemic control. Objective: To evaluate whether, in patients with type 1 diabetes mellitus, the addition of Metformin to insulin and standard diabetes management result in better glycaemic control and lower insulin dosage . Methods: In a clinical trial study 16 children and adolescents with type 1 diabetes with had high insulin intake and HbA1c >8% were participated. HbA1c, FBS, 2hpp BG, insulin dosage and BMI were measured and compared at the onset and end of the treatment. Results: There were significant differences in HbA1c and insulin dosage between the time of 0 of the study and after 4 months of Metformin addition therapy. But there were no significant differences between BMI, FBG and 2 h pp BG at the onset of the study and end of it. Conclusion: Metformin treatment lowered HbA1c and decreased insulin dosage in patients with type 1 diabetes in poor metabolic control. Long term studies will determine if these improvements are sustained.
Keywords: Type 1 diabetes mellitus, Metformin, HbA1c, Fasting, Blood Sugar Introduction:
positive effect of metformin in these pa-
On the convenient feature, until now this
Ninety percent of diabetic patients will
So the purpose of this study was first to
determine if the addition of metformin to
regular diabetes care in type 1 diabetic
patients would improve glycaemic control
as assess by clinical outcomes of lowered
vival.(3) Until now treatment with insulin
Methods and subjects:
ter glycaemic control in type 1 diabetic
Study design:
This was a clinical trial of 4 months dura-
Insulin is an appetite stimulant particu-
pediatric clinic of diabetes in Endocrine
and Metabolism Research center affiliated
insulin is associated with weight gain and
to Isfahan University of Medical Sciences.
obesity is associated with insulin resis-
tance (5) followed by increase of the insu-
written informed permission before entry
lin doses necessary to improve blood glu-
Subjects & Sample size:
used in treatment of patients with type 2
acts by diminishing basal hepatic glucose
production and increasing glucose uptake
bined with insulin in patients with type 1
diabetes. These studies have suggested a
inclusion and exclusion criteria:
To minimize GI side effects, the drug was
injection of insulin NPH plus insulin Regu-
Patients were requested to visit the doc-
tor every month. At each visit they were
Further inclusion criteria included poor
evaluated for metabolic control, protocol
higher) in the previous year, fasting se-
poglyceamic episodes and GI side effects
rum C Peptide <0.18 nmol/lit after injec-
of metformin. Hepatic and renal function
tion of Glucagons, History of diagnosis of
cidosis, and duration of diabetes for at
awareness hypoglyceamia, clinical or bio-
ferences in the subjects before and after
treatment. P value<0.05 was considered
interpretation of the results difficult.
Study protocol and treatment: Results:
mate capillary blood glucose using owns'
ter, at laboratory of the Clinic. They were
asked to check blood glucose at fasting,
2hpp and before evening insulin injection
lycemia and to call the doctor, if needed
patients/parents or the doctor via phone
men of insulin therapy as previously (as
During the study, there were no episodes
metformin because of unpleasant taste of
(before evening insulin injection ) at the
Mean of HbA1C, at the time of 0 of study
trospectively), however this indicator was
end of study it was 8.3±1.2. Paired t test
195±43 mg/dl at the beginning the study
progression, and at the end of the study
it was significantly less than the time of 0
Also there was not significant difference
end of study (20.39±2.7, and 20.42±2.7
Table 1, Comparison of glyceamic control and metabolic indictors before and after the intervention
At the time of At the end of 0 of study Discussion:
tion of weight in patients with type 1 di-
in diabetic children with badly glycaemic
insulin.(7) Our results were inconsistent
with their study; explanation is probably
due to short period of the present study.
result in significant improvement of gly-
accompanied with reduction of total daily
ings of previous studies.(2, 3, and 7) Tatsu-
References:
our patients as their blood glucoses were
1. Goldman , Ausiello .Cecil Medicine.23rd
2. Vaag A, luad S. Effect of metformin in
patients with type 1 Diabetes mellitus with
inadequate Glycemic control by insulin and
diet. National Institate of health.Available
Gov/ct/show/Nct 00118237 (updated 2005).
their previous drug regimen, this causes
3. A.S.A.Khan,C.R. Mcloughney ,A.B. Ahmed
some limitation for the present study e.g.
. The effects of metformin on blood glucose
control in overweight patients with type 1
4. Z.Abdeyazdan, N. Sadeghi, B.Forghani,
et al. Comparison of dietary intake between
children with diabetes mellitus and control
group.Iranian journal of diabetes and Lipid
5. E. Gunton and S.M. Twigg. Metformin use
as an adjunct to Insulin treatment in se-
lected patients with type 1 diabetes mellitus.
clinical trials with larger sample sizes and
Ph.Lehert, N .Cugnardey, P. Drouin,B Guerci
.The Benefits of Metformin therapy during
will copy with this modality of treatment.
treatment of type 1 diabetec patients. Di-
Acknowlodgments:
7. T. Urakami, Sh. Morimoto, M. Owada and
K. Harada. Usefulness of the addition of
metformin to Insulin in pediatric patientis
with type 1 diabetes mellitus. Pediatrics
affiliated to Isfahan University of Medical
tance in data analyses, also our patients
Insulin in type 1 diabetes. Diabetes care
Copyright 2011, Shiraz E Medical Journal. All rights reserved.
L I E S L O D E N W E L L E R Soprano A rare and versatile performer, Liesl Odenweller consistently delights audiences and critics throughout Europe in her unique and exciting interpretations of a wide variety of repertoire. She is the recipient of numerous awards and grants, including the Liederkranz Prize in the US, the International Bellini Prize, and the Italian “Il Virtuoso�
ST. THOMAS’ NURSERY P. O. Box 247 Fort Washington, PA 19034 215-233-2923 HANDBOOK 2013-2014 “Whose child is this?” I asked one day“Mine”, said the parent with a tender smileAnd each day to do the things he should”“Mine”, said the teacher with the same tender “Whose child is this?” I asked once more“Ours” said the parent and the teacher as they And
Shiraz E-Medical Journal 
Introduction: 
To minimize GI side effects, the drug was
injection of insulin NPH plus insulin Regu-
Patients were requested to visit the doc-
tor every month. At each visit they were
Further inclusion criteria included poor
evaluated for metabolic control, protocol
higher) in the previous year, fasting se-
poglyceamic episodes and GI side effects
rum C Peptide <0.18 nmol/lit after injec-
of metformin. Hepatic and renal function
tion of Glucagons, History of diagnosis of
cidosis, and duration of diabetes for at
awareness hypoglyceamia, clinical or bio-
ferences in the subjects before and after
treatment. P value<0.05 was considered
interpretation of the results difficult.
Study protocol and treatment: 
(before evening insulin injection ) at the
Mean of HbA1C, at the time of 0 of study
trospectively), however this indicator was
end of study it was 8.3±1.2. Paired t test
195±43 mg/dl at the beginning the study
progression, and at the end of the study
it was significantly less than the time of 0
Also there was not significant difference
end of study (20.39±2.7, and 20.42±2.7
Table 1, Comparison of glyceamic control and metabolic indictors before and after the intervention
At the time of 
References: