Presentation and effectiveness of early treatment of type 2 diabetes in youth: lessons from the TODAY study

Abstract

Objective The objectives were to: (1) describe the characteristics of a large ethnically/racially and geographically diverse population of adolescents with recent onset type 2 diabetes; and (2) assess effects of short-term diabetes education and treatment with metformin on clinical and biochemical parameters in this cohort. Research Design and Methods Descriptive characteristics were determined for subjects screened for TODAY who met criteria for diagnosis of type 2 diabetes (n=1092). Changes in clinical and biochemical parameters were determined for those who completed at least 8 weeks of the run-in phase of the trial, which included standardized diabetes education and treatment with metformin. Further analysis determined whether these changes differed according to treatment at screening. Main Outcome Measures Demographic, biochemical measurements, and anthropometrics at screening and changes over 8 weeks of run-in. Results Subjects screened for TODAY had a median age of 14 years and median hemoglobin A1c (HbA1c) of 6.9% (52 mmol/mol), 2/3 were female, and ethnic/racial minorities were overrepresented. Dyslipidemia and hypertension were common comorbidities. During run-in, HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and blood pressure significantly improved. Nearly all participants on insulin at screening were able to attain target HbA1c following insulin discontinuation. Conclusions Treatment with metformin and diabetes education provided short-term improvements in glycemic control and cardiometabolic risk factors in a large adolescent T2D cohort. Nearly all insulin-treated youth could be successfully weaned off insulin with continued improvement in glycemic control.

Bariatric Surgery for Adolescents with Type 2 Diabetes: an Emerging Therapeutic Strategy

“…Guidelines from the American Academy of Pediatrics recommend starting insulin on all newly-diagnosed children with type 2 diabetes in whom ketones are present, HBA1c is greater than 9%, fasting blood glucose level is equal to or greater than 250 mg/dl, and/or if the clinician is unable to rule-out the possibility of T1D. Addition of metformin is an effective adjunct to insulin therapy, with the potential to improve HbA1c and allow for insulin discontinuation over a short period of time (19). In addition, at least 60 minutes of physical activity is recommended daily (20); even modest weight loss of <10% can improve glycemic control as assessed by HbA1c(21).…”

Clinical Pharmacokinetics and Pharmacodynamics of Antihyperglycemic Medications in Children and Adolescents with Type 2 Diabetes Mellitus

“…In another cohort of adolescent T2DM participants (n=1092), parameters such as HbA1c , BMI, LDL-C, triglycerides and blood pressure have improved. Treatment with metformin provided short-term improvements in glycemic control and cardiometabolic risk factors, and nearly all insulin-treated youth were eventually weaned off insulin (Table 1) [36] .…”

Update on Youth-Onset Type 2 Diabetes

“…Of the 927 participants who entered the run-in phase, 35.6% had an HbA1c ≥ 8% and 38% were on insulin; the mean HbA1c was 7.7% [8, 9]. Of note, 90.9% of these subjects achieved an HbA1c <8% and nearly all subjects who had been on insulin at screening were able to lower their A1c on metformin to <8% after insulin discontinuation [8, 9].…”

“…Of note, 90.9% of these subjects achieved an HbA1c <8% and nearly all subjects who had been on insulin at screening were able to lower their A1c on metformin to <8% after insulin discontinuation [8, 9]. After the completion of the run-in phase, 223 were not eligible for randomization.…”