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Drugs

, Volume 78, Issue 18, pp 1887–1901 | Cite as

Efficacy of Metformin Treatment with Respect to Weight Reduction in Children and Adults with Obesity: A Systematic Review

  • Y. E. Lentferink
  • C. A. J. Knibbe
  • M. M. J. van der Vorst
Systematic Review

Abstract

Background

Obesity and its related complications are increasing health issues. Since generally only minor weight loss is obtained with lifestyle intervention, additional pharmacological therapies such as metformin are often used.

Objective

We conducted a systematic review to provide an overview of the efficacy of ≥ 6 months of metformin treatment in children and adults with respect to weight, insulin resistance, and progression toward type 2 diabetes mellitus (T2DM).

Methods

In September 2018, we searched PubMed, Embase, and the Cochrane Library for studies published in English using the keywords metformin, obesity/overweight, and weight loss. Prospective studies reporting weight/body mass index (BMI) as a primary or secondary outcome in patients with overweight/obesity with ≥ 6 months’ metformin treatment were included. Included subjects were children and adults with overweight/obesity who received ≥ 6 months of metformin and/or lifestyle intervention, and/or placebo and/or lifestyle intervention, and/or standard care. Studies were independently screened by two reviewers. Data were extracted by one and verified by the other reviewer, and both reviewers assessed the risk of bias using the Cochrane risk-of-bias tool.

Results

Our review includes 15 pediatric and 14 adult studies. In children, after 6 months, more than half the studies reported a greater reduction in BMI with metformin versus controls. Only six studies had an intervention of > 6 months, and these studies found no further improvement in BMI in the metformin users, though their BMI was lower than that of controls. Three studies showed a significant improvement in insulin sensitivity in the metformin versus the control group. Adults using metformin experienced and maintained small decreases in weight irrespective of duration of intervention. In 11 of 14 studies, a greater reduction in weight/BMI was observed with metformin than with placebo. Progression toward T2DM was significantly reduced in adults using metformin, ranging from 7 to 31%. The safety and tolerability of metformin, withdrawal of participants, and comparison with other drugs were not taken into account.

Conclusions

The effects of metformin on weight/BMI vary, with smaller reductions in children than in adults. This could be because of differences in adherence, daily dosage, and insulin status. Metformin significantly reduced the progression toward T2DM in adults. Therefore, metformin should be considered as a treatment for obesity and its related complications.

Notes

Compliance with Ethical Standards

Conflict of interest

Y. Lentferink, C. Knibbe, and M. van der Vorst have no conflicts of interest that are directly relevant to the content of this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Formal consent was not required for this type of study.

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Supplementary material

40265_2018_1025_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of PediatricsSt. Antonius HospitalUtrechtThe Netherlands
  2. 2.Department of Clinical PharmacySt Antonius HospitalUtrechtThe Netherlands
  3. 3.Division of Systems Biomedicine and PharmacologyLACDR, Leiden UniversityLeidenThe Netherlands

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