İnsülin direnci olan obez 10-18 yaş arası hastalarda metformin tedavisinin etkinliğinin geriye dönük incelenmesi
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Date
2022
Authors
Akyel, Nurten Kahraman
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Bu çalışmada, Bursa Uludağ Üniversitesi Tıp Fakültesi, Çocuk Endokrinolojisi Bilim Dalında 1 Ocak 2010 ve 30 Aralık 2019 tarihleri arasında izlenen ve insülin direnci (İR) nedeniyle metformin tedavisi alan 40 obez hastanın tıbbi kayıtları retrospektif olarak incelenmiş ve metformin tedavisi alan obez hastaların başlangıçta, 6. ayda ve 1. yıldaki antropometrik ve metabolik parametreleri karşılaştırılmıştır. Olguların ortalama yaşı 13,60±1,47 yıl ve %60’ı kadın idi En sık başvuru yakınması %87,80 oranında ağırlık fazlalığı idi. Olguların tamamı pubertal dönemde idi. Çalışmada, 1 yıl metformin tedavisi kullanan hastalarda 6. ay ve 1. yıl vücut ağırlığı standart deviasyon skoru (SDS), vücut kitle indeksi (VKİ) ve VKİ SDS değerlerinde istatistiksel olarak anlamlı (p<0,001) düşüş saptanmış ve ciddi bir yan etki gözlenmemiştir. Yine olguların 1. yıl açlık glukoz (p=0,009), açlık insülin (p=0,001), glikolize hemoglobin (HbA1c) (p=0,009), HOMA-IR (insülin direncinin homeostatik model değerlendirmesi) (p=0,001), insülin sensitivite indeksi (p=0,001) ve Quick indeksi (kantitatif insülin duyarlılığı kontrol indeksi) (p=0,005) değerlerinde istatistiksel olarak anlamlı iyileşme saptandı. Metformin tedavisi ile birlikte yaşam tarzı değişikliği gözlenen grupta, yaşam tarzı değişikliği olmadan metformin kullanan gruba göre 1. yılda VKİ SDS (p=0,023), HOMA-IR (p=0,039), Quick indeksi (p=0,044) ve insülin sensitivite indeksinde (p=0,007) anlamlı iyileşme saptandı. Sonuç olarak, insülin direnci olan ve metformin tedavisi alan obez adolesanlarda tedavinin 6. ayında ve 1. yılında antropometrik ve metabolik parametrelerde iyileşme saptanmıştır. Metformin tedavisinin yaşam tarzı değişiklikleri ile birlikte uygulanması kısa dönemde daha güçlü bir etki oluşturuyor gibi görünmektedir. Ancak, adolesan yaş gurubunda metformin tedavisinin uzun dönem etkilerine yönelik daha fazla çalışmaya ihtiyaç vardır.
The medical records of 40 obese patients who were followed up in Bursa Uludağ University Faculty of Medicine, Division of Pediatric Endocrinology between January 1, 2010 and December 30, 2019 and were started on metformin therapy due to insulin resistance (IR), were retrospectively analysed. Anthropometric and metabolic parameters of obese patients receiving metformin treatment at the beginning, sixth month and first year of treatment were compared. The mean age of the cases was 13.60±1.47 years and 60% were female. The most common complaint at presentation was being overweight at a rate of 87.80%. All of the cases were in the pubertal period. A statistically significant (p<0.001) decrease was found in the 6th month and 1st year body weight standard deviation score (SDS), body mass index (BMI) and BMI SDS values in patients who used metformin treatment for 1 year, and no serious side effects were observed. At the same time, statistically significant improvement were found in the 1st year fasting glucose (p=0.009), fasting insulin (p=0.001), glycosylated hemoglobin (HbA1c) (p=0.009), HOMA-IR (homeostatic model evaluation of insulin resistance) (p=0.001), insulin sensitivity index (p=0.001) and Quick index (quantitative insulin sensitivity control index) (p=0.005). In the group in which lifestyle changes were applied in parallel to metformin treatment, BMI SDS (p=0.023), HOMA-IR (p=0.039), Quick index (p=0.044) and insulin sensitivity index (p=0.007) vales were significantly improved. In conclusion, anthropometric and metabolic parameters improved both in the 6th month and 1st year of the treatment in obese adolescents with insulin resistance and metformin treatment. Co-administration of metformin treatment with lifestyle changes seems to have a stronger effect in the short term. However, more studies are needed on the long-term effects of metformin treatment in the adolescent age group.
The medical records of 40 obese patients who were followed up in Bursa Uludağ University Faculty of Medicine, Division of Pediatric Endocrinology between January 1, 2010 and December 30, 2019 and were started on metformin therapy due to insulin resistance (IR), were retrospectively analysed. Anthropometric and metabolic parameters of obese patients receiving metformin treatment at the beginning, sixth month and first year of treatment were compared. The mean age of the cases was 13.60±1.47 years and 60% were female. The most common complaint at presentation was being overweight at a rate of 87.80%. All of the cases were in the pubertal period. A statistically significant (p<0.001) decrease was found in the 6th month and 1st year body weight standard deviation score (SDS), body mass index (BMI) and BMI SDS values in patients who used metformin treatment for 1 year, and no serious side effects were observed. At the same time, statistically significant improvement were found in the 1st year fasting glucose (p=0.009), fasting insulin (p=0.001), glycosylated hemoglobin (HbA1c) (p=0.009), HOMA-IR (homeostatic model evaluation of insulin resistance) (p=0.001), insulin sensitivity index (p=0.001) and Quick index (quantitative insulin sensitivity control index) (p=0.005). In the group in which lifestyle changes were applied in parallel to metformin treatment, BMI SDS (p=0.023), HOMA-IR (p=0.039), Quick index (p=0.044) and insulin sensitivity index (p=0.007) vales were significantly improved. In conclusion, anthropometric and metabolic parameters improved both in the 6th month and 1st year of the treatment in obese adolescents with insulin resistance and metformin treatment. Co-administration of metformin treatment with lifestyle changes seems to have a stronger effect in the short term. However, more studies are needed on the long-term effects of metformin treatment in the adolescent age group.
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Keywords
Adölesan, İnsülin direnci, Obezite, Metformin, Adolescent, Insulin resistance, Obesity, Metformin
Citation
Akyel, N. K. (2022). İnsülin direnci olan obez 10-18 yaş arası hastalarda metformin tedavisinin etkinliğinin geriye dönük incelenmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.