OBJECTIVES: Diabetes is the most common metabolic disease. Agents that have been approved for use in children and adolescents are metformin, insulin, liraglutide and recently exenatide. A systematic review and meta-analysis were conducted to evaluate the efficacy and safety of metformin and the glucagon-like peptide-1 (GLP-1) analogues, exenatide and liraglutide, compared to placebo or other antidiabetic drugs in children and adolescents with T2DM.

METHODS: Relevant data from randomized controlled trials (RCTs) were collected from the PubMed, Cochrane Library, EMBASE and Clinical Trials databases. Glycosylated hemoglobin (HbA1c) was used as a primary outcome indicator and Fasting Plasma Glucose (FPG), Body Mass Index (BMI), Body Weight and Total Adverse Events were used as secondary outcome indicators.

RESULTS: Only 6 out of 744 studies met the criteria for the qualitative analysis. For metformin versus glimepiride, or placebo or metformin with rosiglitazone, the Standardized Mean Difference (SMD) value for HbA1c was -0.67 [95%CI, -1.65, 0.31], for FPG was -0.64 [95% CI, -1.84, 0.56] and for BMI was -0.10 [95%CI, -0.26, 0.05], while the Odds Ratio (OR) value of the total adverse events was 1.14 [95%CI, 0.83, 1.57] indicating that treatment with metformin alone does not appear to offer any clinical advantages over the other interventions. For the GLP-1 analogues versus placebo, the SMD value for HbA1c was -0.38 [95%CI, -0.70, -0.05] and for body weight was -0.22 [95%CI, -0.47, 0.03], but for FPG the SMD value was -0.58 [95%CI, -0.90, -0.25] suggesting that GLP-1 analogues are more effective than placebo.

CONCLUSIONS: Treatment with metformin alone compared to glimepiride, placebo, or metformin with rosiglitazone, does not seem to offer children and adolescent patients with T2DM an added benefit, but the GLP-1 analogues, exenatide and liraglutide, appear to be more effective than placebo and thus may constitute a useful alternative, though further investigation is required.