Pediatric T2D: Lower HbA1c Predicts Better Outcomes With Metformin Monotherapy

A spilled bottle of medicine
A spilled bottle of medicine
Findings accentuate the much greater concern regarding clinical outcomes in participants who did not respond to metformin monotherapy.

Youth presenting with a lower hemoglobin A1c (HbA1c) placed on metformin monotherapy may have more durable metabolic control of type 2 diabetes (T2D), and a shorter duration of diabetes that is independent of age, race-ethnicity, and body mass index, according to a study by Hormone Research in Pediatrics

Researchers obtained data on 276 youth with T2D from the Pediatric Diabetes Consortium T2D Registry and divided them into 2 groups: youth with an HbA1c <7.5% currently on metformin monotherapy (n=75), and youth treated with insulin with or without metformin (n=201). The 2 groups were compared to determine whether there were any identifiable clinical differences in youth with adequate glycemic control on metformin monotherapy compared with youth who required insulin therapy.

It was hypothesized that “higher HbA1c at diagnosis and the need for initial insulin treatment limits the durability of glycemic control on metformin monotherapy, and race and sex differences also affect responses to metformin.”

Study results demonstrated a higher likelihood of adequate T2D control on metformin monotherapy in youth who initially presented with a lower HbA1c at the time of diagnosis compared with youth who were prescribed insulin with or without metformin as initial T2D treatment (P <.001).  In addition, researchers found that the HbA1c level at diagnosis and length of diabetes duration (P =.001 and P =.009, respectively) was associated with adequate control in youth on metformin monotherapy. 

Of note, it was found that for every 0.5% higher HbA1c level in youth at the time of diagnosis, there was a 10% higher risk of not achieving durable glycemic control on metformin monotherapy for an average of 4.2 years after diagnosis.

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Researchers concluded that “durable metabolic control of T2D with metformin monotherapy is more likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and [body mass index].” 

Clinicians should be vigilant to screen for and identify T2D in youth, as well as consider implementing metformin monotherapy in youth who initially present with an HbA1c of <7.5%.


Bacha F, Cheng P, Gal RL, et al. Initial presentation of type 2 diabetes in adolescents predicts durability of successful treatment with metformin monotherapy: insights from the pediatric diabetes consortium T2D registry [published online October 31, 2017]. Horm Res Paediatr. doi:10.1159/000481687