Drugs failing to control type 2 diabetes in children

Oral drug therapies used to treat type 2 diabetes in children and teens who are overweight are not controlling this metabolic disease effectively, according to new research funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study-billed as the first major comparative effectiveness trial for the treatment of type 2 diabetes in young people-found that metformin alone was not an effective treatment for many children and that adding an intensive lifestyle intervention to metformin therapy provided no more benefit.

The study enrolled 699 patients aged 10 to 17 years who had type 2 diabetes for less than 2 years and a body mass index at the 85th percentile or greater. Participants were randomly assigned to 1 of 3 treatment groups: metformin alone, metformin and rosiglitazone together, and metformin plus intensive lifestyle changes. They were followed for an average of 4 years.

Researchers found that treatment with metformin alone was inadequate for maintaining acceptable, long-term, blood glucose control in 51.7% of patients over an average follow-up of 46 months. The failure rate was 38.6% in the metformin and rosiglitazone group, a 25.3% reduction from metformin alone. In the metformin plus lifestyle group, the failure rate was 46.6%.

The lifestyle intervention involved a family-based weight-management program aimed at helping patients lose weight and increase physical activity. It included intensive education and activities delivered one-on-one by trained study staff. Some patients lost weight during the study, but most did not.

The researchers note that increasing childhood obesity has led to increased incidence of type 2 diabetes in children and that most children with type 2 diabetes might require combination drug therapy or insulin for glycemic control within just a few years after diagnosis.

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