A 12-year-old obese boy is found to have fasting plasma glucose of 148 mg/dL and HbA1c of 8.4%. He has acanthosis nigricans and a family history of type 2 diabetes in both parents. C-peptide levels are elevated. Which of the following is TRUE regarding the use of metformin in pediatric type 2 diabetes?

• A Metformin is contraindicated in children under 18 years due to risk of lactic acidosis
• B Metformin should be preceded by at least 6 months of lifestyle modification before initiation, regardless of glycemic severity
• C GLP-1 receptor agonists are preferred over metformin as first-line therapy in obese pediatric patients with T2DM
• D Metformin is approved for use in children aged 10 years and above with T2DM and is the preferred initial pharmacotherapy ✓

Explanation

Metformin is approved (FDA and IAP guidelines) for children with T2DM aged 10 years and above and is the preferred initial pharmacological agent. It reduces hepatic glucose production, improves insulin sensitivity, and is weight-neutral to weight-reducing. While lifestyle modification is initiated concurrently, it does not need to precede pharmacotherapy by 6 months when HbA1c is significantly elevated (as in this case at 8.4%). GLP-1 receptor agonists (e.g., liraglutide) have been more recently approved for adolescents but are not the preferred first-line agent above metformin. Metformin is not contraindicated in children—it is widely used.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.