Metabolic syndrome is common and persistent in youth-onset type 2 diabetes: Results from the TODAY clinical trial

Abstract

Objective To examine the prevalence of metabolic syndrome (MetS) in youth-onset type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods Prevalence of MetS (ATP III definition) was compared at baseline (n=679), 6 (n=625) and 24 months (n=545) using chi-square tests. Laboratory data were examined between MetS classifications at each time point using ANOVA. Results Baseline prevalence of MetS was 75.8% and did not differ by treatment group or change over time. MetS was more common in females (83.1%) than males (62.3%; p<0.0001) at baseline; this difference persisted over 24 months. Prevalence of MetS was similar between ethnic groups at baseline, but greater in Hispanics (82.7%) vs non-Hispanic Whites (67.5%; p=0.0017) and non-Hispanic Blacks (72.7%;p=0.0164) at 24 months. Although MetS was common in participants with A1c <7.0% (74.4% at baseline; no significant change over 24 months), it was more common in those who did not maintain glycemic control at 6 months (80.3%; p=0.0081). Elevated c-reactive protein, ALT, IL6 and PAI-1 levels were more frequent with MetS. Conclusions Persistent high prevalence of MetS in youth-onset diabetes, even with excellent glycemic control, is of concern given the associated increased cardiovascular risk.

New directions for diabetes prevention and management in behavioral medicine

“…Unfortunately, screening rates are low, and the majority of people living with prediabetes are undiagnosed—estimates are that while 86 million people have prediabetes, 90 % are unaware of this (Centers for Disease Control and Prevention, 2014). The emergence of increased type 2 diabetes prevalence in youth (Weinstock et al, 2015) highlights the extent of the crisis of prediabetes and type 2 diabetes and is a harbinger of future burden. Engagement in healthy eating and physical activity can significantly reduce the risk of individuals with prediabetes from developing type 2 diabetes.…”

Update on Youth-Onset Type 2 Diabetes

“…The TODAY study found the prevalence of metabolic syndrome to be 75.8% at randomization [14]. Neither the overall prevalence nor incidence of metabolic syndrome significantly changed in first two years of the trial.…”

“…Neither the overall prevalence nor incidence of metabolic syndrome significantly changed in first two years of the trial. Further there were no differences in the prevalence of metabolic syndrome among the three treatment arms[14]. Table 2 displays the prevalence of metabolic syndrome in TODAY subjects by sex, race/ethnicity, and glycemic status.…”

“…Metabolic syndrome was more common in female subjects (83.1%) compared to their male counterparts (62.3%) and this difference persisted over time. The factors contributing to the difference between sexes were a higher likelihood of abdominal obesity and low HDL cholesterol in female subjects[14]. The prevalence of metabolic syndrome among subjects with different racial/ethnic backgrounds was similar at baseline and 6 months after the study began.…”

“…However after two years, 82.7% of Hispanics had metabolic syndrome, which was significantly higher than the rate observed in non-Hispanic blacks (72.7%) and non-Hispanic whites (67.5%). Low levels of triglycerides in non-Hispanic blacks and low HDL cholesterol levels in Hispanics contributed to these differences[14]. Subjects who reached glycemic failure in the study were more likely to have metabolic syndrome at 6 months and had higher rates of hypertriglyceridemia and hypertension[14].…”