Treatment of Type 2 Diabetes in Youth

Flint, Amanda; Arslanian, Silva

doi:10.2337/dc11-s215

Cited by 47 publications

(43 citation statements)

References 49 publications

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“…Despite the escalating rates of obesity-driven type 2 diabetes in youth, therapeutic options remain limited to metformin, the only FDA-approved oral hypoglycemic agent for children, and insulin when the former fails (1). Even though metformin was effective in the short-term over 16 weeks (2), it remained unknown whether this effect was durable until the results of the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) trial showed >50% failure rates on metformin over an average follow-up of 3.86 years (3).…”

mentioning

confidence: 99%

Effects of Metformin, Metformin Plus Rosiglitazone, and Metformin Plus Lifestyle on Insulin Sensitivity and β-Cell Function in TODAY

2013

Diabetes Care

236

108

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OBJECTIVEThe Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial demonstrated that combination therapy with metformin plus rosiglitazone provided superior durability of glycemic control compared with metformin alone, with significantly lower treatment failure rates (38.6 vs. 51.7%), and metformin plus lifestyle was intermediate. Herein we describe the temporal changes in measures of β-cell function and insulin sensitivity over a 4-year period among the three treatments.RESEARCH DESIGN AND METHODSTODAY participants (699) were tested periodically with an oral glucose tolerance test to determine insulin sensitivity (1/fasting insulin [1/IF]), insulinogenic index (△I30/△G30) or C-peptide index (△C30/△G30), and β-cell function relative to insulin sensitivity (oral disposition index [oDI]).RESULTSDuring the first 6 months, metformin plus rosiglitazone exhibited a significantly greater improvement in insulin sensitivity and oDI versus metformin alone and versus metformin plus lifestyle; these improvements were sustained over 48 months of TODAY. Irrespective of treatment, those who failed to maintain glycemic control had significantly lower β-cell function (∼50%), higher fasting glucose concentration, and higher HbA1c at randomization compared with those who did not fail.CONCLUSIONSThe beneficial change in insulin sensitivity and the resultant lower burden on β-cell function achieved in the first 6 months with metformin plus rosiglitazone appear to be responsible for its superior glycemic durability over metformin alone and metformin plus lifestyle. However, initial β-cell reserve and HbA1c at randomization are independent predictors of glycemic durability. Therefore, efforts to preserve β-cell function before significant loss occurs and to reduce HbA1c may be beneficial in the treatment of youth with type 2 diabetes.

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confidence: 99%

Effects of Metformin, Metformin Plus Rosiglitazone, and Metformin Plus Lifestyle on Insulin Sensitivity and β-Cell Function in TODAY

2013

Diabetes Care

236

108

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“…7 An HbA 1c target in the near-normal range of <7.0% (<53 mmol/mol) is appropriate in these patients. 27 Choice of pharmacotherapy should aim to preserve β-cell function and improve insulin sensitivity. At present, metformin is the only oral anti-hyperglycaemic agent approved for use in children and adolescents.…”

Section: Children and Adolescentsmentioning

confidence: 99%

Individualized glycaemic targets and pharmacotherapy in type 2 diabetes

Bailey

Aschner

Prato

et al. 2013

Diabetes and Vascular Disease Research

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The Global Partnership for Effective Diabetes Management, established to provide practical guidance to improve patient outcomes in diabetes, has developed and modified recommendations to improve glycaemic control in type 2 diabetes. The Global Partnership advocates an individualized therapeutic approach and, as part of the process to customize therapy, has previously identified specific type 2 diabetes patient subgroups that require special consideration. This article builds on earlier publications, expanding the scope of practical guidance to include newly diagnosed individuals with complications and women with diabetes in pregnancy. Good glycaemic control remains the cornerstone of managing type 2 diabetes, and plays a vital role in preventing or delaying the onset and progression of diabetic complications. Individualizing therapeutic goals and treatments to meet glycaemic targets safely and without delay remains paramount, in addition to a wider programme of care to reduce cardiovascular risk factors and improve patient outcomes.

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“…It is important to note that there are no evidence-based guidelines for glycemic goals for teens with T2D, and HbA1c targets include 7% or less for American Diabetes Association, Canadian Diabetes Association, and International Society of Pediatric and Adolescent Diabetes [7, 16, 28] and is set at 6.5% for International Diabetes Federation [29]. …”

Section: Management Of T2d In Children and Adolescentsmentioning

confidence: 99%

Management of Pediatric and Adolescent Type 2 Diabetes

Samaan

2013

International Journal of Pediatrics

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Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents.

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Treatment of Type 2 Diabetes in Youth

Cited by 47 publications

References 49 publications

Effects of Metformin, Metformin Plus Rosiglitazone, and Metformin Plus Lifestyle on Insulin Sensitivity and β-Cell Function in TODAY

Effects of Metformin, Metformin Plus Rosiglitazone, and Metformin Plus Lifestyle on Insulin Sensitivity and β-Cell Function in TODAY

Individualized glycaemic targets and pharmacotherapy in type 2 diabetes

Management of Pediatric and Adolescent Type 2 Diabetes

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