Young people require new approach to diabetes treatment
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone, preserved the body’s ability to make insulin.
Dr Steven Kahn, Professor of Medicine at the University of Washington School of Medicine said, “These findings tell us that the treatments that work on adults and that we currently use for type 2 diabetes in youth are not as effective as we would like and therefore we need to develop new approaches to treat adolescents with the disease.”
The results come from a study of 91 obese young people aged between 10–19 years with type 2 diabetes or impaired glucose tolerance, part of the larger RISE (Restoring Insulin Secretion) study. Trials in the RISE Consortium are among the first to directly compare young people with type 2 diabetes to their adult counterparts. To determine if early, aggressive treatment would improve outcomes, participants at four study sites were randomly assigned to one of two treatment groups. The first group received three months of glargine, a long-acting insulin, followed by nine months of metformin. The second received only metformin for 12 months. Participants were then monitored for three more months after treatment ended. Beta cell function was assessed by hyperglycaemic clamp at baseline, after 12 months treatment and at 15 months.
No significant differences were observed between treatment groups at baseline, 12 months, or 15 months in beta cell function, BMI percentile, HbA1c, fasting glucose, or oral glucose tolerance test 2-hour glucose results. There were modest improvements in blood glucose level but the study found that beta cell function declined in both groups during treatment and worsened after treatment ended.
“These studies provide critical new information that helps us better understand why type 2 diabetes seems to progress more rapidly in young people. This is important news given the growing epidemic of this disease in youth,” Dr Kahn said.
The longer a person has type 2 diabetes, the greater the likelihood of developing complications including heart, kidney, eye, and nerve diseases, making it critical for young people with type 2 diabetes to quickly achieve and sustain control of their blood glucose. However, because type 2 diabetes has historically been an adult condition, information about how to effectively treat youth is limited, and paediatric diabetes experts have had to rely on best practices for adult treatment – an imperfect translation given the differences in physiology between the groups.
Beta cell dysfunction is key in the pathogenesis of paediatric type 2 diabetes. Numerous studies highlight that type 2 diabetes in youth is more aggressive than in adults. This study shows that insulin glargine and metformin are not able to slow disease progression and that there is a need for treatments that work more effectively in young people.
RISE Consortium. Impact of insulin and metformin versus metformin alone on β-cell function in youth with impaired glucose tolerance or recently diagnosed type 2 diabetes. Diabetes Care 2018;41(8):1717-25.
RISE study https://rise.bsc.gwu.edu/
Credit: UW School of Medicine newsroom 2018