Current Perspectives on Management of Type 2 Diabetes in Youth

Abstract

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is on the rise, and the increase in prevalence of this disorder parallels the modern epidemic of childhood obesity worldwide. T2DM affects primarily post-pubertal adolescents from ethnic/racial minorities and those from socioeconomically disadvantaged backgrounds. Youth with T2DM often have additional cardiovascular risk factors at diagnosis. T2DM in youth is more progressive in comparison to adult onset T2DM and shows lower rates of response to pharmacotherapy and more rapid development of diabetes-related complications. Lifestyle modifications and metformin are recommended as the first-line treatment for youth with T2DM in the absence of significant hyperglycemia. Assessment of pancreatic autoimmunity is recommended in all youth who appear to have T2DM. Pharmacotherapeutic options for youth with T2DM are limited at this time. Liraglutide, a GLP-1 agonist, was recently approved for T2DM in adolescents 10 years of age and older. Several clinical trials are currently underway with youth with T2DM with medications that are approved for T2DM in adults. Bariatric surgery is associated with excellent rates of remission of T2DM in adolescents with severe obesity and should be considered in selected adolescents.

The effects of probiotic administration on patients with prediabetes: a meta-analysis and systematic review

“…For obese children, probiotics may work by promoting lipid metabolism, increasing GLP-1 secretion, raising leptin levels and regulating intestinal flora homeostasis. Firstly, several studies have shown that GLP-1 agonists (e.g., liraglutide) could be effective for weight loss in pediatric patients [71,72]. In our systematic review, probiotics were found to increase GLP-1 secretion in vivo, which is essential for promoting insulin secretion through the action of intestinal proinsulin.…”

Bariatric Surgery in Adolescents: To Do or Not to Do?

“…Metformin, a biguanide, represents the first-choice medication. It is administered orally and acts to reduce glucose levels, inhibiting the process of hepatic gluconeogenesis and promoting intestinal absorption of glucose [ 47 , 48 , 49 ]. Although metformin does not often result in significant body weight loss, it appears to prevent or delay alteration of glucose homeostasis in children at high risk of developing type 2 diabetes mellitus [ 50 ].…”

Phytochemical Profiling in Conjunction with In Vitro and In Silico Studies to Identify Human α-Amylase Inhibitors in Leucaena leucocephala (Lam.) De Wit for the Treatment of Diabetes Mellitus

“…15,16 Currently, several synthetic antidiabetic drugs are available to lower blood glucose level: metformin, sulfonylureas, meglitinides, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium− glucose cotransporter-2 inhibitors. 17,18 Natural products and traditional herbal medicines also have potential antidiabetic efficacy. 19−21 Naturally occurring chemical compounds in plants, called phytoconstituents, can inhibit α-amylase and be used to manage blood glucose level in T2DM with fewer side effects than those caused by synthetic agents.…”

“…Currently, several synthetic antidiabetic drugs are available to lower blood glucose level: metformin, sulfonylureas, meglitinides, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium–glucose cotransporter-2 inhibitors. , …”