Does Metformin improve vascular function in youth with Type 1 diabetes

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Cardiovascular disease is the leading cause of mortality in type 1 diabetes (T1D). Prevention of vascular complications of diabetes requires strategies that begin early in the disease process. Risk factors in childhood track into adulthood and correlate with early markers of atherosclerosis such as vascular endothelial and smooth muscle function. We have shown that children and adolescents with type 1 diabetes have detectable endothelial and smooth muscle dysfunction that relate to body mass index (BMI). A significant number of youth with T1D are also overweight with insulin resistance. Metformin reduces insulin requirements and weight gain in type 1 diabetes. In type 2 diabetes Metformin substantially reduces risk of cardiovascular events and improves endothelial function. However there are no studies of cardiovascular outcomes or their earlier cardiovascular markers in type 1 diabetes despite the increasing prevalence of overweight status in this population and the fact that this is a major modifiable risk factor for cardiovascular disease. Determining the effect of Metformin on vascular function in overweight youth with type 1 diabetes in a double blind randomized placebo controlled parallel trial will provide additional strategies to intervene in early in the process of atherosclerosis.