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Targeted therapy may improve glycemic control in youth-onset type 2 diabetes
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More targeted therapy may be helpful in identifying youth with type 2 diabetes at risk for rapid loss of glycemic control, according to recent study findings.
“The TODAY primary outcome analysis demonstrated that type 2 diabetes presenting during adolescence was characterized by high rates of loss of glycemic control over a relatively brief period of time compared with adults,” the researchers wrote. “Although addition of rosiglitazone to metformin reduced the rate of loss of glycemic control by 23% over the course of the study, the median time to glycemic failure was the same regardless of treatment assignment.”
Kathyrn Hirst
Kathryn Hirst, PhD, of George Washington University Biostatistics Center in Washington, D.C., and colleagues evaluated data from the TODAY study, a randomized clinical trial of adolescents with type 2 diabetes, to determine whether clinically accessible parameters early in youth-onset type 2 diabetes can predict the likelihood of durable control on oral therapy. Participants were divided into two groups: those who remained in glycemic control for at least 48 months of follow-up (group 1; n = 172), and those who did not remain in glycemic control before 48 months (group 2; n = 305).
The researchers found that only HbA1c (P < .0001) and insulinogenic index (P = .0002) remained significant in multivariate models that included all baseline demographic and metabolic factors significant in univariate analysis only. For each 0.1% increase in HbA1c from baseline and 0.1-unit decrease in insulinogenic index from baseline, there was a 16% (for both) increased odds of failing within 48 months.
The groups were distinguished with an HbA1c cutoff of 6.3%, and sex-specific cutoffs were 6.3% for girls and 5.6% for boys.
“These findings suggest that HbA1c obtained after a short course of metformin monotherapy in adolescents with type 2 diabetes may be a simple clinical measure to predict short- and medium-term outcome and allow better targeting of therapy to those adolescents at higher risk for loss of glycemic control,” the researchers wrote. “In the future, long-term follow-up of the TODAY cohort will be used to confirm and readjust our analysis and understanding of early markers for both diabetes control and diabetes-related complications and comorbidities.” – by Amber Cox
Disclosure: Hirst reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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