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Childhood type 2 diabetes: a preventable and difficult to treat disease

Robin Wulffson MD's picture
type 2 diabetes, children, teens, treatment challenge, health impact

Primarily due to the increase in childhood obesity, the incidence of type 2 diabetes is increasing in children. In fact, two decades ago, the disease was generally considered to be an adult disease. Complicating treatment is the fact that the disease is more difficult to treat in children. To address this challenge, the researchers evaluated a combination of drug therapies. Their findings were reported online on April 29 in The New England Journal of Medicine.

The investigators compared the effectiveness of three treatment regimens for type 2 diabetes in 669 patients from 10 to 17. The subjects were initially treated with metformin (1,000 mg twice daily) to attain a glycated hemoglobin level of less than 8% (glycated hemoglobin measures the degree of diabetes control0. The patients were randomly assigned to continued treatment with metformin alone, or to metformin combined with rosiglitazone (4 mg twice a day), or a lifestyle-intervention program focusing on weight loss through eating and activity behaviors.

Of the 699 subjects (average duration of diagnosed type 2 diabetes, 7.8 months), 319 (45.6%) achieved control of their diabetes over an average follow-up of 3.86 years. Rates of failure were 51.7% (120 of 232 participants) for metformin alone, 38.6% (90 of 233) for metformin plus rosiglitazone, and 46.6% (109 of 234) for metformin plus lifestyle intervention. The authors noted that metformin plus rosiglitazone was superior to metformin alone; metformin plus lifestyle intervention was intermediate but not significantly different from metformin alone or metformin plus rosiglitazone. The investigators found ethnic and gender differences among the group. Sustained effectiveness with metformin alone was least effective in non-Hispanic black patients and metformin plus rosiglitazone most effective in girls. Serious adverse events were reported in 19.2% of participants.

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The authors concluded that monotherapy (single drug therapy) with metformin was associated with long-lasting glycemic control in approximately half of children and adolescents with type 2 diabetes. Furthermore, the addition of rosiglitazone, but not an intensive lifestyle intervention, was superior to metformin alone.

Take home message:
This study points to a particularly worrisome component of the current obesity epidemic in the United States. As in adult type 2 diabetes, the condition is related to excess weight and obesity; thus, it is largely a preventable disease. Type 2 diabetes is related to a host of health conditions such as cardiovascular disease, kidney failure, and loss of vision. Thus, a childhood diagnosis has a much greater impact on an individual than a diagnosis later in adult life. A child diagnosed with the condition can look forward to a future with significant health problems and an early death. A healthy diet and exercise program that results in a return to a normal weight can improve blood sugar control even to the point of reversal of the condition.

Children with type 2 diabetes present special challenges. Meal plans should consider the amount of calories needed for growth. Three smaller meals and three snacks are often required to meet calorie needs. To increase compliance to a healthy diet, children should be given some—but not an excessive amount—of slack. For example, when attending a party or during holidays, your child may still eat sugary foods; however, that should be counteracted with fewer carbohydrates during other times of that day. Thus, if your child eats birthday cake, Halloween candy, or other sweets, they should NOT have the usual daily amount of potatoes, pasta, or rice. This substitution helps keep calories and carbohydrates in better balance.

Reference: The New England Journal of Medicine

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