Objective: Metabolic control often deteriorates during puberty in children with type 1 diabetes. The aim of the present study was to investigate whether addition of metformin for 3 months improves metabolic control and insulin sensitivity. Design: Twenty-six of 30 randomised adolescents with type 1 diabetes (18 females, eight males) completed a double-blind placebo-controlled trial. Their mean age was 16.9^1.6 (S.D.) years, mean glycated haemoglobin (HbA 1c ) 9.5^1.1% and daily insulin dosage 1.2^0.3 U/kg. The participants were randomised to receive oral metformin or placebo for 3 months. HbA 1c was measured monthly, and peripheral insulin sensitivity was assessed by a euglycaemic hyperinsulinaemic clamp at baseline and at the end of the study. Results: HbA 1c decreased significantly in the group treated with metformin, from 9.6 to 8.7% (P , 0.05), but was unchanged in the placebo group (9.5 vs 9.2%). Peripheral glucose uptake divided by mean plasma insulin concentration was increased in the metformin group (P , 0.05) but not in the placebo group. Initial insulin sensitivity was inversely correlated to changes in HbA 1c (r ¼ 20.62; P , 0.05) and positively correlated to changes in insulin sensitivity (r ¼ 0.77; P , 0.01). Conclusions: In this double-blind placebo-controlled study we found that metformin improves metabolic control in adolescents with type 1 diabetes. The effect seems to be associated with an increased insulin-induced glucose uptake.

In this study the prevalence of eating disorders in a population-based cohort of 89 female patients with type 1 diabetes, 14-18 y of age, was compared with that in age-matched healthy controls. Of all diabetic girls in the study area, 92% participated in the study. The majority were treated with multiple insulin injections and the mean HbA1c of the participants was 8.4%. On average, diabetic girls were 6.8 kg heavier than the controls. A two-stage design was used. The first consisted of a validated self-report questionnaire, the Eating Disorder Inventory (EDI). Girls who had high scores were then interviewed about eating habits and mental health using a semistructured interview, the BAB-T (Assessment of Anorexia-Bulimia - Teenager version). No cases of anorexia or bulimia nervosa were found, but 15 diabetic patients (16.9%) compared with 2 control girls (2.2%), p<0.01, had disturbed eating behaviour according to the questionnaire. In 6 of these 15 diabetic girls an eating disorder was confirmed at the interview, mainly binge eating and self-induced vomiting. None of the control girls showed an eating disorder. Overweight diabetic girls scored higher on EDI than non-overweight diabetic girls (chi2 = 4.9; p = 0.038). No relationships were found between EDI scores and metabolic control (HbA1c), dose of insulin, frequency of hypoglycaemia or diabetic ketoacidosis.

Engström I, Kroon M, Arvidsson C-G, Segnestam K, Snellman K, Å man J. Eating disorders in adolescent girls with insulin-dependent diabetes mellitus: a population-based case-control study. Acta Paediatr 1999; 88: 175-80. Stockholm. ISSN 0803-5253 In this study the prevalence of eating disorders in a population-based cohort of 89 female patients with type 1 diabetes, 14-18 y of age, was compared with that in age-matched healthy controls. Of all diabetic girls in the study area, 92% participated in the study. The majority were treated with multiple insulin injections and the mean HbA 1c of the participants was 8.4%. On average, diabetic girls were 6.8 kg heavier than the controls. A two-stage design was used. The first consisted of a validated self-report questionnaire, the Eating Disorder Inventory (EDI). Girls who had high scores were then interviewed about eating habits and mental health using a semistructured interview, the BAB-T (Assessment of Anorexia-Bulimia -Teenager version). No cases of anorexia or bulimia nervosa were found, but 15 diabetic patients (16.9%) compared with 2 control girls (2.2%), p`0.01, had disturbed eating behaviour according to the questionnaire. In 6 of these 15 diabetic girls an eating disorder was confirmed at the interview, mainly binge eating and self-induced vomiting. None of the control girls showed an eating disorder. Overweight diabetic girls scored higher on EDI than non-overweight diabetic girls (w 2 = 4.9; p = 0.038). No relationships were found between EDI scores and metabolic control (HbA 1c ), dose of insulin, frequency of hypoglycaemia or diabetic ketoacidosis. & Adolescence, diabetes mellitus, eating disorder, insulin dependent, overweight J Å man,

No abstract

Domargård A, Särnblad S, Kroon M, Karlsson I, Skeppner G, Å man J. Increased prevalence of overweight in adolescent girls with type 1 diabetes mellitus. Acta Paediatr 1999; 88: 1223-8. Stockholm. ISSN 0803-5253 Height and weight were measured in young patients with type 1 diabetes up to the age of 22 y. We found no difference between birth length standard deviation scores (SDS), final height SDS and target height SDS. The study group of 89 diabetic boys and girls did not differ in final height from age-and sex-matched healthy controls. SDS for height at diagnosis, 0.17 AE 1.10, exceeded that for final height, À0.06 AE 0.97 (p = 0.037). Height SDS decreased between the ages of 11 and 18 (p`0.01). In diabetic girls, but not boys, final height SDS was significantly related to mean HbA 1c during puberty (r = À0.40; p = 0.025). Weight gain occurred from age of menarche in girls with type 1 diabetes. At the age of 18, diabetic girls were 6.5 kg heavier and had 2.7 kg/m 2 higher body mass index (BMI) than control girls (p`0.001). Diabetic boys were not heavier than control boys. There was a significant relationship between mean HbA 1c during puberty and BMI at the age of 18 in diabetic girls (r = 0.47; p = 0.009). In diabetic females, body weight remained unchanged, HbA 1c improved and the dose of insulin was significantly reduced between 18 and 22 y of age. The HbA 1c improvement was most marked in patients with poor metabolic control. In conclusion, although mean final height was normal in young patients with type 1 diabetes, growth was increased before diagnosis and pubertal growth spurt was reduced. Adolescent overweight was overrepresented; it related to poor metabolic control in females with diabetes, but showed no further acceleration in early adulthood. & Adolescence, growth, overweight, type 1 diabetes J Å man,