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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Review Article

Efficacy and Safety of Metformin for Obesity: A Systematic Review

Reem Masarwa, Vanessa C. Brunetti, Stephanie Aloe, Mélanie Henderson, Robert W. Platt and Kristian B. Filion
Pediatrics March 2021, 147 (3) e20201610; DOI: https://doi.org/10.1542/peds.2020-1610
Reem Masarwa
aCenter for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;
bEpidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;
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Vanessa C. Brunetti
aCenter for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;
bEpidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;
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Stephanie Aloe
aCenter for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;
cDivision of Endocrinology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada;
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Mélanie Henderson
dDepartment of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and University of Montreal, Montreal, Quebec, Canada; and
eCentre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada
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Robert W. Platt
aCenter for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;
bEpidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;
fDepartments of Pediatrics,
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Kristian B. Filion
aCenter for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;
gMedicine, and
bEpidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;
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Abstract

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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.

  • Accepted October 30, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 3
1 Mar 2021
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Efficacy and Safety of Metformin for Obesity: A Systematic Review
Reem Masarwa, Vanessa C. Brunetti, Stephanie Aloe, Mélanie Henderson, Robert W. Platt, Kristian B. Filion
Pediatrics Mar 2021, 147 (3) e20201610; DOI: 10.1542/peds.2020-1610

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Efficacy and Safety of Metformin for Obesity: A Systematic Review
Reem Masarwa, Vanessa C. Brunetti, Stephanie Aloe, Mélanie Henderson, Robert W. Platt, Kristian B. Filion
Pediatrics Mar 2021, 147 (3) e20201610; DOI: 10.1542/peds.2020-1610
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