Adolescents with type 2 diabetes benefit from specific treatments to help them maintain their blood glucose levels, new research has found.
When young people with the condition start on their healthcare programme they can be less than vigilant and often lose control of their blood glucose and struggle with regularising their weight and lifestyle.
Now a study, known as the Treatment Options for Type 2 Diabetes in Youth study (TODAY), has found that adolescents with a HbA1c level above 6.3% three months after beginning drug treatment with metformin have nearly four times the risk of losing glucose control within 11 months.
It is the largest clinical trial to study the treatment of youth onset type 2 diabetes and randomly assigned participants to one of three treatment groups to examine optimal approaches for disease management: metformin alone, metformin and rosiglitazone together, or metformin plus an intensive lifestyle programme aimed to help them lose weight and increase exercise.
The researchers examined blood glucose levels through the A1C test, which measures a person’s average levels of blood glucose over a three-month period. Typically, a person without diabetes should have an A1C measurement below 5.7% while an A1C above 6.5% is considered diagnostic for diabetes. People who have diabetes often aim for an A1C below 7% as a marker of good control.
The study found that 50% failed treatment with metformin, the first drug generally used in treatment of type 2 diabetes. This failure rate is much higher than that seen with metformin in adult patients, suggesting that progression of the disease may be more aggressive in some youth than adults.
At the same time, the study showed that 50% of participants were able to maintain glucose control regardless of treatment group. These results suggested that there may be at least two distinct populations of youth with type 2 diabetes, where one group needs intensive therapy to maintain blood glucose levels and the other does not.
The researchers looked again at the data to see if they could understand if they could predict early on which patients would fall into which group. The ability to predict the outcome early on would allow appropriate treatment measures to be instituted to prevent loss of control of blood glucose in those who will need additional treatment, while avoiding excessive therapy for those who will be able to manage their disease adequately on metformin alone.
This analysis indicated that the A1C test is an easily obtained clinical marker that effectively distinguishes the two groups and may provide important treatment information to providers. Furthermore, the A1C cut-off that distinguishes those who will need early intensive therapy of 6.3% is lower than expected and lower than the target generally considered to indicate good control.
“These results already have changed my own clinical practice when caring for youth who have A1C values that are on target but above the cut off we’ve identified,” said Phil Zeitler, chair for the TODAY study and professor and head of the Section of Endocrinology, Department of Paediatrics at the University of Colorado School of Medicine. “With the current results, I am much more likely to recommend intensification of therapy among youth in this population group who have not attained a non-diabetic A1C, even if they have reached targets generally recommended for adults by the American Diabetes Association.”
The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.