Young people with type 2 diabetes face increased risk of heart and kidney disease

by Barbara Hewitt on May 27, 2013

Young people with type 2 diabetes face increased risk of heart and kidney disease

Young people with type 2 diabetes face increased risk of heart and kidney disease

Young people with type 2 diabetes experience a more rapid progression of complications than adults even when they receive the best currently available treatment and close monitoring of their condition, American scientists have found. The American Diabetes Association says that the latest findings from the ongoing Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) are a ‘grave cause for concern’.

The study shows that young people who develop type 2 diabetes are heading for a future of serious complications including high blood pressure, kidney disease, eye complication and heart disease. It concludes that current treatment options are inadequate and most drugs known to successfully treat adults have not been studied in children or approved by the Federal Drugs Agency to treat younger people with diabetes.

‘The study has shown that youth with type 2 diabetes can face faster consequences than their adult counterparts,’ said Dr Griffin Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, which funded the study. ‘Given the disease’s more rapid progression in youth, the need for better treatment and prevention cannot be overlooked,’ he added.

Those taking part in the study were randomly assigned to one of three treatment arms: metformin alone; metformin plus rosiglitazone; and metformin plus an intensive lifestyle intervention that included diet, exercise and counselling on how to lose weight. ‘We’re seeing a continuation of the way diabetes behaves differently in youth, and it’s a serious cause for concern at a time when they should be entering the most productive period of their lives. Instead of going to college and getting jobs, they will be visiting doctors and dealing with serious health care issues,’ said Phil Zeitler, Professor of Paediatrics at the University of Colorado and chairman of the TODAY study.

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Though it cannot currently be recommended for use as treatment in youth, adding rosiglitazone to metformin as a treatment not only reduced the need to transition participants to insulin therapy, it appears to have done so because it helped to preserve beta cell function, the most recent findings suggest. ‘The message here is that if you are going to treat youth with type 2 diabetes effectively, it must be done early and aggressively targeting to improve beta cell function and insulin resistance,’ said Silva Arslanian, Professor of Paediatric Endocrinology and director of the Weight Management and Wellness Center at the Children’s Hospital of Pittsburg.

Both hypertension and kidney disease progressed rapidly regardless of treatment. Males were at an 81% higher risk of developing high blood pressure than females. As boys grew older, their risk for developing hypertension increased. In contrast, gender did not appear to impact the increased incidence of early kidney disease which rose overall from 6.3% of participants at the beginning of the study to 16.6% after 3.9 years. The scientists said that it was poor glycaemic control that influenced whether kidney disease progressed.

Regardless of which treatment arm they were in, participants also experienced a worsening of cardiovascular risks. The percentage with so called ‘bad’ cholesterol LDL rose over 12 months and then stabilised over the next 24 months. Though researchers expected the group treated with metformin plus intensive lifestyle interventions to experience greater weight loss and improvements in body composition, those gains were smaller than they hoped for and any positive effects were lost by 24 months.

‘This does not say that lifestyle changes are not important. What it says is that reductions in body fat and BMI through lifestyle change are extremely hard to accomplish in this age group. The implications are that the time to intervene is before diabetes develops,’ said Dr Kenneth Copeland of the University of Oklahoma College of Medicine.

Dr Zeitler also reiterated the importance of prevention. ‘We need to prevent diabetes. Before that, we need to prevent childhood obesity. Before that, we need to prevent pregnancies complicated by obesity and diabetes. There is a huge societal intervention that needs to happen,’ he said.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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