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An obese, 12 year old girl comes for review in clinic. A year ago when you first saw her you gave comprehensive advice regarding dietary modification, and exercise. She has continued to gain weight with a BMI greater than the 99th centile. You arrange for an oral glucose tolerance test to be performed which shows her to be hyperinsulinaemic with fasting insulin of 20 mIU/l, and 120 min insulin of 200 mIU/l. She has normal fasting and 120 min blood glucose measurements. You wonder whether prescribing metformin may help her to lose weight.
Structured clinical question
In obese hyperinsulinaemic adolescents [patient] is metformin [intervention] effective in promoting weight loss [outcome]?
Search strategy and outcome
Secondary (Cochrane library, 2004) and primary (Medline, Embase) sources were included in the search.
Search strategy: “Obesity” AND “Adolescent” AND “Metformin”.
Search outcome: 276 hits (14; 61; 201; each search respectively), of which 2 (2; 2; 0) studies were directly relevant to this question. …