Diabetes Treatment Helps Reduce Increased Weight in Children with ASD
Double-blind randomized clinical trial published in JAMA Psychiatry looks at outcomes of 60 children with autism spectrum disorder who were overweight due to side effects of antipsychotic medications
(August 24, 2016) – A new study published in the Journal of the American Medical Association (JAMA) Psychiatry showed significant evidence that common type-2 diabetes drug metformin is effective in helping overweight children and adolescents with autism spectrum disorder (ASD) who take antipsychotic medications keep or lower their body mass index (BMI).
Risperidone and aripiprazole are FDA-approved antipsychotic medications for treating irritability and agitation symptoms in children and adolescents with ASD, a diagnosis that affects 1 in 68 children and the fastest growing and most commonly diagnosed neurological disorder in Canada. Both medications can cause a significant increase in weight gain, which in addition to increasing BMI enhances long-term risk of diabetes. This complicates an already challenging issue given recent data from Centres for Disease Control and Prevention showing adolescents with ASD were approximately two times more likely to be obese than adolescents without developmental disabilities.
“It is critically important that we investigate new ways to support healthy outcomes as early as possible for those who are on these medications,” says Dr. Evdokia Anagnostou, principal author on the study and senior clinician scientist and co-lead of Holland Bloorview Kids Rehabilitation Hospital’s Autism Research Centre. “Use of antipsychotics to help manage irritability associated with ASD can sometimes be long-term which means we need to provide families with solutions that support lasting optimal health in their children.” Anagnostou is a Canada Research Chair in Translational Therapeutics (Tier II).
In collaboration with international specialists from multiple sites, including Holland Bloorview in Toronto, Ohio State University, University of Pittsburgh, Columbia University Medical Center (CUMC), and Vanderbilt University, they recruited 60 children ages 6-17 with ASD and led a double-blind, placebo-controlled randomized clinical trial to explore the effectiveness of metformin in counteracting weight gain associated with antipsychotic medications.
Results of the study showed that metformin was effective and well-tolerated in decreasing ongoing weight gain associated with antipsychotic use in children and adolescents with ASD. Metformin reduced BMI scores from the initial baseline significantly more than the placebo group.
“This is a very special group, as young people with ASD present with many unique challenges. By definition, they experience communication difficulties, and they’re reported to have more GI difficulties than most other patient groups,” said Dr. Michael Aman, lead investigator at Ohio State University’s Nisonger Center. “As GI problems can be a side effect of metformin, it was important that the research teams be skilled in communication with such children. Our results showed that GI side effects occurred for more days in the metformin group, but the large majority of children taking metformin were able to maintain their treatment. Importantly, the metformin didn’t cause behavioural changes, such as increased irritability.”
Little previous research to date has examined treatment or prevention of weight gain in children and youth with ASD. “These results have already changed my clinical practice,” said Dr. Veenstra-VanderWeele, the Mortimer D. Sackler, MD, Associate Professor of Psychiatry at CUMC and the NewYork-Presbyterian Center for Autism and the Developing Brain, and research scientist at New York State Psychiatric Institute,. “I now prescribe metformin instead of abandoning medicines, like risperidone, that can sometimes dramatically improve the lives of children with autism but also often cause unhealthy weight gain. This provides another option instead of the painful choice between protecting long-term physical health and treating agitation symptoms that can lead to injury or exclusion from an appropriate school setting.”