비만형 2형 당뇨병 환아에서 Metformin의 효과
The Effect of Metformin in Obese Pediatric Patients with Type 2 Diabetes
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목 적 : 2형 당뇨병의 치료에 있어 식이 조절 및 운동 요법과 함께 약물 요법이 병행되는 경우가 많다. 경구용 혈당강하제 중 Biguinide 계열은 체중의 증가가 나타나지 않아 비만한 환자에게 유용한 것으로 보고하고 있다. 소아 2형 당뇨에서 Biguinide 계열인 metformin 투여에 대한 국내 연구가 적은 실정이다. 저자들은 약물 요법 시행중인 소아 2형 당뇨병 환아들을 대상으로 약물 치료 1년 후, 2년 후의 신체계측지수 변화 및 혈당, 당화혈색소, 지질 변화 등에 대한 연구를 시행하였다. 방 법 : 본 연구는 소아 내분비과에 내원하여 소아 2형 당뇨를 처음 진단받은 비만한 환아 36명을 대상으로 하였으며, metformin 단독투여군(n=16), metformin과 sulfonylurea 혼합투여군(n=14), sulfonylurea 단독투여군(n=7)으로 구분하였다. 외래를 통해 신체계측지수 및 생화학적 검사를 시행하였으며, 약물 치료 1년 후, 2년 후의 변화값을 측정하였다. 결 과 : 대상 환아들을 대상으로, 약물 치료 시작 1년후, 2년 후 신체계측지수, 생화학검사치의 변화를 측정하였으며, metformin 단독투여군에서 공복 혈당 및 당화 혈색소가 감소되어 혈당 조절이 잘되며, 혈중 지질 농도에 부정적 영향을 주지 않음을 알 수 있었다. 또한 치료 1년 후, 2년 후의 체질량지수가 유의하게 감소하는 소견을 보였다(P<0.05). 결 론 : 저자들은 본 연구를 통하여 Biguanide계열의 metformin이 소아 2형 당뇨병에서 체질량지수의 감소에 효과가 있음을 알 수 있었다. 소아 2형 당뇨에서 혈당 조절이 원활히 되면서, 체중 증가가 나타나지 않아 비만한 환자에게 유용한 것으로 생각된다.
Abstract
Purpose : Metformin is well-established oral hypoglycemic agent for adults and children with type 2 diabetes mellitus. In adults, metformin is effective as initial monotherapy with lack of weight gain. But, its beneficial role on obesity in children is less clearly defined. We assessed the effects of metformin in obese children with type 2 diabetes. Methods : We evaluated body weight, height, body mass index, fasting blood sugar, HbA1c, lipid profiles in obese 36 children with type 2 diabetes treated with oral hypoglycemic agents at baseline, after 1 year and 2 years of treatment. We divided the subjects into three groups: metformin monotherapy, combination metformin with sulfonylurea, sulfonylurea monotherapy. The changes from baseline in three groups were measured. Results : The decrease in body mass index, blood sugar & HbA1c was observed after treatment with metformin monotherapy group. Metformin monotherapy group after 1 & 2 years of treatment had a greater effect for body mass index (-1.9±1.7 kg/m2, -1.5±1.6 kg/m2, P<0.05). Conclusion : The Metformin monotherapy for obese children with type 2 diabetes improves glycemic control with benefits of significant improvement in body mass index.
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