Youth with type 2 diabetes struggle to maintain glycemic control

Less than half of youth with newly diagnosed type 2 diabetes can control their blood sugar levels successfully with metformin therapy alone, according to a study published in the New England Journal of Medicine.

Metformin is a first-line oral medication to treat type 2 diabetes. It decreases the amount of glucose absorbed from food and the amount of glucose produced by the liver. Metformin is widely used, inexpensive and has a relatively few side effects.

At the beginning of the study, almost 700 youth age 10 to 17 years were treated with metformin to achieve a glycated hemoglobin level of less than 8 percent. Then, they were randomly assigned to continue treatment with metformin alone, metformin with rosiglitazone, or metformin with a lifestyle intervention program focusing on weight loss.

Within an average of less than 12 months, about 46 percent of all participants lost glycemic control. Only about 48 percent of teens on metformin alone could maintain their target blood sugar levels.

Metformin plus rosiglitazone produced the best results, with the combination successful in about 61 percent of patients. This occurred despite a small increase in body mass index (BMI) and fat mass in this treatment group.

Rosiglitazone, sold under the brand name Avandia, is a type 2 diabetes drug in the thiazolidinediones class of medications. The medication has a risk of serious side effects and is currently under restricted status in the United States and Europe.

Meanwhile, researchers found that metformin therapy plus lifestyle intervention was only slightly more successful than metformin therapy alone at a success rate of 53 percent.

Although metformin plus lifestyle intervention significantly decreased percent of overweight participants, researchers found that this did not translate into sustained glycemic control. Neither BMI at baseline nor BMI over time determined failure to maintain blood sugar levels.

“These results suggest that a majority of youth with type 2 diabetes may require combination treatment or insulin therapy within a few years after diagnosis,” wrote the study's authors.

Type 2 diabetes in youth has increased with the epidemic of childhood obesity. Since the duration of diabetes and the lack of glycemic control can increase the risk of complication in adults, metabolic control in youth is crucial.

“Addressing the physiological and psychological changes that normally occur during adolescence requires a high level of family involvement and makes the achievement of stringent treatment goals especially difficult in the case of adolescents with diabetes,” wrote the authors of the study.

The also note that those challenges are especially difficult for disadvantaged populations, which represent a higher proportion of youth with type 2 diabetes.

Sources: New England Journal of Medicine, National Institutes of Health

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