Meliksah KESKİN, Zehra AYCAN, Uğur Ufuk ISIN, Semra ÇETİNKAYA

Metformin ile tedavi edilen non-diyabetik obez çocuk ve adolesanların uzun sureli izlemi

Amaç: Çocukluk döneminde obezite artan sıklıkla izlenen önemli bir halk sağlığı problemidir. Tip 2 Diyabetes mellitus (T2DM) obezite ve metabolik sendrom ile güçlü ilişki içindedir. Tip 2 DM ‘nin önlenmesi için obezite ve insulin direncini hedef alan ilaç tedavileri rasyonel bir strateji olarak görülmektedir.Çalışmamızın amacı bir yıl süre ile metformin tedavisi alan çocuk ve adolesanlarda bu tedavinin uzun dönem etkinliğini değerlendirmektir.Gereç ve Yöntemler: Kliniğimizde obezite (VKI>+ 2SDS ) tanısı alan ve insulin direnci olan (OGTT’de total insulin düzeyi >300 mIU/ml ve homa IR >3,4 ) ve diğer obezite ilişkili komorbiditeleri bulunan, yaşları 10-18 arası değişen, yaşam tarzı değişikliği ile birlikte bir yıl süre ile metformin tedavisi alan ve ardından en az iki yıl süre ile takip edilen hastalar dahil edildi. Bulgular: Çalışmaya 8’ i kız , ortalama yaşı 13,2±2,1 yıl olan ve ortalama izlem süresi 3,9±1 yıl olan toplam 12 dahil edildi. Başlangıçta olguların vücut kitle indeksi (VKİ) 31,2±5,6 kg/m2ve VKİ-SDS’i 2,7±0,7 iken bir yıllık metformin tedavisi ile VKİ-SDS’inin 1,9±1 (p:0,04) ‘ e gerilediği, iki yıl süre ile metformin tedavisi kesilen olguların VKİ-SDS’ inin 2,1±1,04 (p:0,033)’ e yükseldiği ancak metformin tedavisi öncesi kadar yüksek olmadığı görüldü. Sonuç: Bir yıllık metformin tedavisinin obez çocuk ve adolesanlarda VKİ-SDS ve Homa-IR değerlerinde düzelme sağladığı, bu düzelmenin tedavi kesiminden sonraki ikinci yılda da azalmakla birlikte devam ettiği saptandı.

Anahtar Kelimeler:

Obezite, insülin direnci, Çocukluk dönemi

Long-term follow-up of non-diabetic obese children and adolescents treated with metformin

Aim: Childhood obesity is an important public health problem with increasing prevalence.Type 2 diabetes mellitus(T2DM) is strongly associated with obesity and metabolic syndrome. Adressing obesity and insulin resistance by drug treatment represents a rational strategy for the prevention of T2DM. The aim of our study was to evaluate the one year metformin treatment’slong-term effectiveness in children and adolescent.Material and Methods: Patients who were diagnosed with obesity (VKİ>+2 SDS)and found to have insulin resistance (total insulin at OGTT >300 mIU/ml and homa-IR >3.4)and other obesity co-morbidities, agedbetween 10-18 years, treated with metformin in addition to lifestyle change for a year and with regular follow-up for a minimum of 2 years after metformin treatmentin our clinicwere included inthe study.Results: A total of 12 cases including 8 girls with a mean age of 13.2±2.1 years and mean follow-up duration of 3.9±1 years were included in the study. While the body mass index (BMI) of the cases at presentation was 31.2±5.6 kg/m2 and BMI-SDS was 2.7±0.7, the BMI-SDS value after one year of metformin treatment was found to have regressed to 1.9±1 (p:0.04), and the BMI-SDS value two years after the interruption of metformin treatment had increased to 2.1±1.04 but was not as high as the period before metformin treatment (p:0.033). Conclusion: One-year metformin treatment improved the BMI SDS and homa-IR values of the obese children and this improvement decreased but continued in the second year after the discontinuation of the treatment.

Keywords:

Obesity, insulin resistance, childhood,

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