(HealthDay News) – Youth with type 2 diabetes have high rates of serious complications, with a disease trajectory that is distinct from that in adults, according to findings from the ongoing Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study published online May 23 in Diabetes Care.
Researchers from the TODAY study randomized >500 youth (aged 10–17 years) with type 2 diabetes to receive metformin alone, metformin and rosiglitazone, or metformin plus intensive lifestyle interventions (diet, exercise, and weight loss counseling).
The researchers found that randomization to rosiglitazone plus metformin was associated with an improvement in insulin sensitivity and preserved beta-cell function vs. the other treatment groups. In all treatment arms, the incidence of hypertension increased from 11.6–33.8% after 3.9 years of follow-up, with males at greater risk. Microalbuminuria rates also increased, from 6.3 at baseline to 16.6% after follow-up. Cardiovascular risk also worsened in all arms, and the percentage requiring cholesterol-lowering medications increased from 4.5–10.7% of participants over 36 months. Within the TODAY population, 13.7% of participants developed non-proliferative retinopathy after an average diabetes duration of 4.9 years. For the metformin plus lifestyle intervention group, weight loss and improvement in body composition was smaller than expected, and effects were lost by 24 months.
“We are not prepared as a medical community or as a global society at this time to effectively address the growing problem of type 2 diabetes in youth,” William Cefalu, MD, the editor-in-chief of Diabetes Care, writes in an accompanying editorial. “To state that we have a huge challenge ahead and no real solutions is an understatement.”
Several pharmaceutical companies made donations in support of the TODAY study’s efforts.