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Effect of metformin on clinical and biochemical hyperandrogenism in adolescent girls with type 1 diabetes

  • Mona Hafez , Noha Musa EMAIL logo , Shaimaa Elbehairy , Sahar Abdel Atty , Menna Elbarbary and Maha Amin
Published/Copyright: April 22, 2019
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 32 Issue 5

Abstract

Background

Hyperandrogenism with or without polycystic ovarian syndrome is seen in adolescents with type 1 diabetes (T1D), especially those with suboptimal control.

Objective

To assess the effect of metformin on hyperandrogenism and ovarian function in adolescents with T1D.

Methods

This prospective study included 28 T1D females showing signs of hyperandrogenism. History taking (detailed diabetes history and menstrual history) and anthropometric measurements (weight, height, body mass index [BMI], waist and hip circumference) were initially performed, and then the patients were assessed for the manifestations of hyperandrogenism (acne, hirsutism as well as pelvic ultrasound [U/S] for ovarian morphology). Biochemical evaluation for ovulation (progesterone assessment during the luteal phase), sex steroids (estradiol, testosterone, dehydroepiandrosterone sulfate [DHEAS] and androstenedione), prolactin, glycemic control (hemoglobin A1c [HbA1c]) and gonadotropin levels (follicle stimulating hormone [FSH] and luteinizing hormone [LH]) was done. Patients were subjected to 500 mg metformin twice daily orally for 1 year, and then the patients were re-evaluated for clinical and biochemical parameters.

Results

Metformin therapy resulted in a significant reduction in weight (p = 0.001), BMI (p = 0.002), acne (p = 0.008), hirsutism score (0.007), LH (p = 0.008), testosterone (p < 0.001) and androstenedione levels (p = 0.028) in adolescent girls with T1D. Regarding menstrual irregularities, there was a significant reduction in the number of patients with oligomenorrhea (68%) with a p value of <0.001. However, there were no significant reduction in the daily insulin requirements (p = 0.782) or HbA1c (p = 0.068). Nausea and/or abdominal pain were the commonly reported side effects of metformin (64%).

Conclusions

Metformin as an insulin sensitizing agent improved the BMI and cycle regularity together with clinical and biochemical hyperandrogenism in T1D adolescent girls. However, it did not improve their glycemic control.

Keywords: adolescent girls; hyperandrogenism; metformin; polycystic ovary syndrome; type 1 diabetes

Acknowledgments

We acknowledge the doctors and nurses in the Diabetes, Endocrine and Metabolism Pediatric Unit, Cairo University and Dr. Noha Asem who did the statistical methods for this study. We also acknowledge the patients and their parents for their adherence to the treatment and the regular follow-up.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Compliance with ethical standards

  7. Conflict of interest: The authors have no potential conflict of interest to disclose.

  8. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of Cairo University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

  9. Informed consent: Informed consent was obtained from every individual participant included in the study or her legal guardian.

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Received: 2018-10-04
Accepted: 2019-03-07
Published Online: 2019-04-22
Published in Print: 2019-05-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Using height-corrected definition of metabolic syndrome in children and adolescents
  4. Association between early antibiotic exposure and risk of childhood weight gain and obesity: a systematic review and meta-analysis
  5. Original Articles
  6. Carbonated beverage consumption is associated with lower C-peptide in adolescents
  7. Low levels of cardiorespiratory fitness and abdominal resistance are associated with metabolic risk in schoolchildren
  8. Effect of metformin on clinical and biochemical hyperandrogenism in adolescent girls with type 1 diabetes
  9. Obesity-related thyroiditis in childhood: relationship with insulin resistance
  10. An isolated Xp deletion is linked to autoimmune diseases in Turner syndrome
  11. Non-invasive assessment of aortic stiffness and blood pressure in young Turner syndrome patients
  12. High frequency of non-classical congenital adrenal hyperplasia form among children with persistently elevated levels of 17-hydroxyprogesterone after newborn screening
  13. The “combined team” transition clinic model in endocrinology results in high adherence rates and patient satisfaction
  14. Utilizing health information technology to improve the recognition and management of life-threatening adrenal crisis in the pediatric emergency department: medical alert identification in the 21st century
  15. Testicular adrenal rest tumors in patients with congenital adrenal hyperplasia: 6 years of follow-up
  16. Letter to the Editor
  17. Growth failure in infancy and early adiposity rebound
  18. Short Communication
  19. Clinical utility of stimulation tests in infants with suspected adrenal insufficiency (AI)
  20. Case Reports
  21. Two siblings with Gaucher type 3c: different clinical presentations
  22. Acquired partial lipodystrophy with metabolic disease in children following hematopoietic stem cell transplantation: a report of two cases and a review of the literature
  23. Therapeutic challenges in a patient with the simple virilizing (SV) form of congenital adrenal hyperplasia (CAH) due to the P30L/I172N genotype
https://doi.org/10.1515/jpem-2018-0430
Keywords for this article
adolescent girls; hyperandrogenism; metformin; polycystic ovary syndrome; type 1 diabetes

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Using height-corrected definition of metabolic syndrome in children and adolescents
  4. Association between early antibiotic exposure and risk of childhood weight gain and obesity: a systematic review and meta-analysis
  5. Original Articles
  6. Carbonated beverage consumption is associated with lower C-peptide in adolescents
  7. Low levels of cardiorespiratory fitness and abdominal resistance are associated with metabolic risk in schoolchildren
  8. Effect of metformin on clinical and biochemical hyperandrogenism in adolescent girls with type 1 diabetes
  9. Obesity-related thyroiditis in childhood: relationship with insulin resistance
  10. An isolated Xp deletion is linked to autoimmune diseases in Turner syndrome
  11. Non-invasive assessment of aortic stiffness and blood pressure in young Turner syndrome patients
  12. High frequency of non-classical congenital adrenal hyperplasia form among children with persistently elevated levels of 17-hydroxyprogesterone after newborn screening
  13. The “combined team” transition clinic model in endocrinology results in high adherence rates and patient satisfaction
  14. Utilizing health information technology to improve the recognition and management of life-threatening adrenal crisis in the pediatric emergency department: medical alert identification in the 21st century
  15. Testicular adrenal rest tumors in patients with congenital adrenal hyperplasia: 6 years of follow-up
  16. Letter to the Editor
  17. Growth failure in infancy and early adiposity rebound
  18. Short Communication
  19. Clinical utility of stimulation tests in infants with suspected adrenal insufficiency (AI)
  20. Case Reports
  21. Two siblings with Gaucher type 3c: different clinical presentations
  22. Acquired partial lipodystrophy with metabolic disease in children following hematopoietic stem cell transplantation: a report of two cases and a review of the literature
  23. Therapeutic challenges in a patient with the simple virilizing (SV) form of congenital adrenal hyperplasia (CAH) due to the P30L/I172N genotype
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