Glycemic Control with Metformin or Insulin Therapy in Adolescents with Type 2 Diabetes Mellitus

BACKGROUND: Only metformin and insulin are approved by the FDA for adolescents. OBJECTIVE: To study the efficacy of insulin versus metformin in adolescents with type 2 diabetes mellitus (DM2) and examine whether psychosocial factors affect therapeutic efficacy. METHODS: Phase I involved a retrospective examination of the medical records of 18 adolescents with DM2. Glycemic control was evaluated by mean HbA1c. We tested for relationships between glycemic control and BMI, number of outpatient visits per year, and self-reported compliance. Phase II employed a pilot questionnaire. RESULTS: Glycemic control deteriorated when therapy was changed from insulin (HbA1c, 5.0+/-2.6% [SD]) to metformin (8.4+/-2.9%; p <0.05). Self-reported compliance positively predicted glycemic control (p <0.005) and inversely correlated with degree of weight loss (p <0.05). Pilot questionnaire data suggested that patients may perceive their DM as less serious when treated with metformin. CONCLUSIONS: Metformin was often ineffective in our adolescents with DM2 and compliance was a major factor. Altered perception of the seriousness of their DM may have influenced adherence to therapy.