title: Glycemic control with metformin or insulin therapy in adolescents with type 2 diabetes mellitus.
abstract: 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.
authors.affiliation: Department of Pediatrics, Rhode Island Hospital and Brown University, Providence, RI 02903, USA. pkadmon@lifespan.org
authors.forename: Penny M
authors.initials: PM
authors.lastname: Kadmon
authors.forename: Philip A
authors.initials: PA
authors.lastname: Gruppuso
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008499:Medical Records; D008687:Metformin / Q000008:administration & dosage*; D010865:Pilot Projects; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D008687:Metformin