Review: more evidence needed for metformin in children with type 2 diabetes

A child tests her blood sugar

Metformin is usually the first line of active treatment for type 2 diabetes in adults. However, like many drugs its safety and effectiveness has not be adequately studied in children.  With more children being diagnosed as type 2, should metformin also be the first port of call for them?

Clinical question:

In children and adolescents with type 2 diabetes, does metformin, as compared with alternative treatments, improve glycaemic control?

The outcomes of interest were glycaemic control (% HbA1c), diabetes complications and adverse effects such as hypoglycaemia.

The evidence:

Only two randomized trials were found.  One of them compared metformin with glimepiride whilst the other used a placebo control.

For glycaemic control, no significant difference was found between metformin and glimepiride, whilst metformin was found to be significantly better than placebo.

Appraisal hints:

  • The search was carried out in 2008.  Look for more recent studies.
  • Although only two trials were found, the reviewers are not consistent or comprehensive in how they report the outcomes of these trials.
  • The trials were too short to address long-term outcomes and too small to assess rarer adverse events.
  • Better, larger studies are needed in this area – indeed may already have been carried out – to guide practice.


The full text of this paper is available from PubMed Central:

Al-Shareef MA, Sanneh AF, Aljoudi AS. Clinical effect of metformin in children and adolescents with type 2 diabetes mellitus: A systematic review and meta-analysis. J Family Community Med. 2012 May;19(2):68-73.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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