Correlates of Treatment Patterns Among Youth With Type 2 Diabetes

Abstract

OBJECTIVETo describe treatment regimens in youth with type 2 diabetes and examine associations between regimens, demographic and clinical characteristics, and glycemic control.RESEARCH DESIGN AND METHODSThis report includes 474 youth with a clinical diagnosis of type 2 diabetes who completed a SEARCH for Diabetes in Youth study visit. Diabetes treatment regimen was categorized as lifestyle alone, metformin monotherapy, any oral hypoglycemic agent (OHA) other than metformin or two or more OHAs, insulin monotherapy, and insulin plus any OHA(s). Association of treatment with demographic and clinical characteristics (fasting C-peptide [FCP], diabetes duration, and self-monitoring of blood glucose [SMBG]), and A1C was assessed by χ2 and ANOVA. Multiple linear regression models were used to evaluate independent associations of treatment regimens and A1C, adjusting for demographics, diabetes duration, FCP, and SMBG.RESULTSOver 50% of participants reported treatment with metformin alone or lifestyle. Of the autoantibody-negative youth, 40% were on metformin alone, while 33% were on insulin-containing regimens. Participants on metformin alone had a lower A1C (7.0 ± 2.0%, 53 ± 22 mmol/mol) than those on insulin alone (9.2 ± 2.7%, 77 ± 30 mmol/mol) or insulin plus OHA (8.6 ± 2.6%, 70 ± 28 mmol/mol) (P < 0.001). These differences remained significant after adjustment (7.5 ± 0.3%, 58 ± 3 mmol/mol; 9.1 ± 0.4%, 76 ± 4 mmol/mol; and 8.6 ± 0.4%, 70 ± 4 mmol/mol) (P < 0.001) and were more striking in those with diabetes for ≥2 years (7.9 ± 2.8, 9.9 ± 2.8, and 9.8 ± 2.6%). Over one-half of those on insulin-containing therapies still experience treatment failure (A1C ≥8%, 64 mmol/mol).CONCLUSIONSApproximately half of youth with type 2 diabetes were managed with lifestyle or metformin alone and had better glycemic control than individuals using other therapies. Those with longer diabetes duration in particular commonly experienced treatment failures, and more effective management strategies are needed.

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study

“…The current cross‐sectional analysis confirms earlier SEARCH findings that the majority of youths with type 2 diabetes are largely being treated with metformin and/or insulin, which are the only 2 diabetes medications approved for use in children . There was little to no use of other ODMs, such as DPP‐4 inhibitors or incretin mimetics, which have been more recently approved for use in adults.…”

“…Expanding on the earlier SEARCH analysis by Badaru et al, the current analysis also examined the longitudinal changes in medication patterns and glycemic control over time, with an additional follow‐up of 7 years, on average, after the baseline visit. The results show that only 35% of participants were at A1C goal (<7.0%, 53 mmol/mol) at follow‐up, including approximately 50% of those who reported use of metformin monotherapy at both baseline and follow‐up.…”

“…The SEARCH for Diabetes in Youth study reported that the majority of youths with incident type 2 diabetes (n = 474) diagnosed in 2002 to 2005 were largely being treated with metformin and/or insulin approximately 2 years after diagnosis. 5 Greater than 50% of the participants were not adequately controlled (A1C ≥ 8%, 64 mmol/ mol), including >50% of those taking insulin-containing therapies alone or in combination with other therapies. With an increasing number of diabetes therapies currently approved for use in adults, the goal of the current study was to expand on the earlier SEARCH work to examine more contemporary treatment patterns and glycemic control over a longer duration of follow-up for adolescents and young adults with newly diagnosed type 2 diabetes .…”

“…The SEARCH for Diabetes in Youth study reported that the majority of youths with incident type 2 diabetes ( n = 474) diagnosed in 2002 to 2005 were largely being treated with metformin and/or insulin approximately 2 years after diagnosis . Greater than 50% of the participants were not adequately controlled (A1C ≥ 8%, 64 mmol/mol), including >50% of those taking insulin‐containing therapies alone or in combination with other therapies.…”

Type 2 Diabetes Mellitus in Children and Adolescents: Early Prevention and Non-Drug Therapy

“…After 6 months both groups, with no significant differences, had increased insulin sensitivity and lower BMI scores in comparison to control groups [85]. [86]. These studies strongly suggest that, for obese patients, lifestyle interventions, optionally supplemented with medication, provide effective treatment.…”