What is the best way to treat metabolic syndrome in teenagers, especially females with polycystic ovary syndrome? Should I prescribe metformin and statins when efforts to encourage exercise and a healthy diet have failed?
—Jana Tomsky, MD, Walnut Creek, Calif.

Metabolic syndrome presents many challenges and very few solutions. Treatment of type 2 diabetes is the only indication for metformin administration approved by the FDA. That has not stopped metformin use in many off-label situations, e.g., obesity, polycystic ovary syndrome, etc. When the metformin is stopped, however, most of the gains are lost and little ultimate progress is made. Statins may be helpful, but long-term studies in teenagers have not been done. Exercise and weight loss are much harder pills to swallow but may be the only long-term solution other than preventing metabolic syndrome in the first place.
—Michael E. Ryan, DO (107-9)

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