Linked Article: This article is linked to the article by Hsia et al. on pp. 135–139 of the January 2012 issue. To view this article online visit http://dx.doi.org/10.1111/j.1365-2125.2011.04063.x
Unlicensed use of metformin in children and adolescents in Germany and France
Article first published online: 6 JAN 2012
© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 73, Issue 2, pages 307–308, February 2012
How to Cite
Kostev, K. and Richter, H. (2012), Unlicensed use of metformin in children and adolescents in Germany and France. British Journal of Clinical Pharmacology, 73: 307–308. doi: 10.1111/j.1365-2125.2011.04099.x
- Issue published online: 6 JAN 2012
- Article first published online: 6 JAN 2012
- Accepted manuscript online: 25 OCT 2011 05:58AM EST
- RECEIVED; 16 August 2011; ACCEPTED; 30 August 2011; ACCEPTED ARTICLE; 25 October 2011
In the epidemiological study of Hsia et al. , the use of metformin in children and adolescents aged 0–18 years in the UK was investigated based on data from the UK database of IMS Disease Analyzer. Our longitudinal data (2000–2010) from similar databases in Germany (IMS Disease Analyzer Germany)  and France (IMS Disease Analyzer France) partly confirmed these results.
We found 195 children aged 1–18 years with 623 metformin prescriptions in 121 German practices and 269 children with 575 metformin prescriptions in 165 practices in France. In Germany, 74.3% of patients were female; of these, 62.6% were aged 16–18 years. In France, 54.6% of patients were female, out of whom 19.2% were aged 16–18 years.
The main indication for the prescription of metformin was diabetes mellitus, with the majority of patients having a diagnosis of type 2 diabetes. In Germany, metformin was prescribed in 80.8% of female and 85.3% of male patients for diabetes type 2. In France, these figures were 91.1 and 93.0%, respectively. The share of diabetes as a prescription indication is rather different in Germany and France from that which Hsia et al.  reported for the UK, where polycystic ovary syndrome was the most common indication for metformin prescriptions in girls. In the UK, however, 290 of 337 (86.1%) patients had at least one diagnosis of diabetes, even if it was not specified as the indication for the metformin prescription (Figure 1).
In several studies, metformin was shown to be safe and effective as a treatment for type 2 diabetes in paediatric patients . Metformin was approved by the US Food and Drug Administration (FDA) for use in adults with type 2 diabetes in 1994 .
Our primary care data confirm the results of the study of Hsia et al.  regarding the age and gender structure of children treated with metformin in Germany. The main difference between their study and our analysis concerns the documented indications for metformin in Germany and France. The reason for this may, however, be related more to the documentation behaviour of doctors.
There are no competing interests to declare.