Aurora, CO—Adding to growing evidence that type 2 diabetes is more aggressive in the young, a new study finds that neither starting with metformin alone nor initial treatment with long-acting insulin followed by metformin helped preserve beta-cell function in adolescents and preadolescents.
The research, published online by Diabetes Care and presented concurrently at the American Diabetes Association Scientific Sessions in Orlando, Florida, focused on 91 young patients, aged 10 to 19 years who were part of the Restoring Insulin Secretion (RISE) study. Participants, all of them overweight or obese, had either impaired glucose tolerance (IGT), 60%, or type 2 diabetes of less than 6 months duration (40%).
In an effort to determine the effect of early, aggressive treatment on outcomes, University of Colorado Anschutz Medical Center–led researchers randomly assigned the patients to one of two treatment groups. The first received 3 months of glargine with a target glucose of 4.4 to 5.0 mmol/L followed by 9 months of metformin, while the second was prescribed only metformin for 12 months, with monitoring continuing for 3 months after treatment end.
The study team assessed beta-cell function, i.e., insulin sensitivity plus beta-cell responses, for 12 months (on treatment), and 15 months (3 months off treatment).
Results indicate that, in both treatment groups, beta-cell function was significantly lower at 12 and 15 months versus baseline. Study authors concluded, “In youth with IGT or recently diagnosed type 2 diabetes, neither three months of glargine followed by nine months of metformin nor 12 months of metformin alone halted the progressive deterioration of beta-cell function. Alternate approaches to preserve beta-cell function in youth are needed.”
“Only two drugs are currently approved for youth with type 2 diabetes, and we were disheartened to find that neither effectively slows disease progression,” explained Dr. Ellen Leschek, MD, project scientist for the RISE Consortium and program director in the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) Division of Diabetes, Endocrinology, and Metabolic Diseases. “Type 2 diabetes in youth has grown with the obesity epidemic, and we need treatments that work for kids. It’s clear from this study and others that type 2 diabetes in youth is more aggressive than in adults.”
The principal investigator pointed out, however, that while the RISE pediatric group’s treatments did not preserve or improve beta cell function, results showed modest improvement in blood glucose with metformin in both groups.
“Metformin is still a useful method to lower the blood glucose levels of youth with type 2 diabetes, but metformin alone is not a long-term solution for many youth,” noted Kristen Nadeau, MD, MS, principal investigator of the RISE Pediatric Medication Study and professor of pediatric endocrinology at the University of Colorado, Anschutz Medical Campus. “As RISE shows, there is an urgent and growing need for more research to find options to adequately slow or prevent progression of type 2 diabetes in youth.”
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The research, published online by Diabetes Care and presented concurrently at the American Diabetes Association Scientific Sessions in Orlando, Florida, focused on 91 young patients, aged 10 to 19 years who were part of the Restoring Insulin Secretion (RISE) study. Participants, all of them overweight or obese, had either impaired glucose tolerance (IGT), 60%, or type 2 diabetes of less than 6 months duration (40%).
In an effort to determine the effect of early, aggressive treatment on outcomes, University of Colorado Anschutz Medical Center–led researchers randomly assigned the patients to one of two treatment groups. The first received 3 months of glargine with a target glucose of 4.4 to 5.0 mmol/L followed by 9 months of metformin, while the second was prescribed only metformin for 12 months, with monitoring continuing for 3 months after treatment end.
The study team assessed beta-cell function, i.e., insulin sensitivity plus beta-cell responses, for 12 months (on treatment), and 15 months (3 months off treatment).
Results indicate that, in both treatment groups, beta-cell function was significantly lower at 12 and 15 months versus baseline. Study authors concluded, “In youth with IGT or recently diagnosed type 2 diabetes, neither three months of glargine followed by nine months of metformin nor 12 months of metformin alone halted the progressive deterioration of beta-cell function. Alternate approaches to preserve beta-cell function in youth are needed.”
“Only two drugs are currently approved for youth with type 2 diabetes, and we were disheartened to find that neither effectively slows disease progression,” explained Dr. Ellen Leschek, MD, project scientist for the RISE Consortium and program director in the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) Division of Diabetes, Endocrinology, and Metabolic Diseases. “Type 2 diabetes in youth has grown with the obesity epidemic, and we need treatments that work for kids. It’s clear from this study and others that type 2 diabetes in youth is more aggressive than in adults.”
The principal investigator pointed out, however, that while the RISE pediatric group’s treatments did not preserve or improve beta cell function, results showed modest improvement in blood glucose with metformin in both groups.
“Metformin is still a useful method to lower the blood glucose levels of youth with type 2 diabetes, but metformin alone is not a long-term solution for many youth,” noted Kristen Nadeau, MD, MS, principal investigator of the RISE Pediatric Medication Study and professor of pediatric endocrinology at the University of Colorado, Anschutz Medical Campus. “As RISE shows, there is an urgent and growing need for more research to find options to adequately slow or prevent progression of type 2 diabetes in youth.”
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