As the obesity rate among young people has climbed, so has the rate of type 2 diabetes. Adolescents who get the disease may face more health problems than those who get it as an adult.
Concerned with the spike in childhood diabetes, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) has been sponsoring nationwide research to find the best ways to treat the disease.
The program, called Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY), recently reported that children who develop type 2 diabetes are at high risk to develop heart, kidney and eye problems faster and at a higher rate than people who acquire type 2 diabetes as adults.
Jane Lynch, MD, professor of pediatric endocrinology in the School of Medicine at The University of Texas Health Science Center at San Antonio, led the investigation, which followed 699 children and young people for two to six years.
Ranging in age from 10 to 17, participants in the TODAY study were overweight or obese and were diagnosed as having type 2 diabetes within two years of their enrollment, which was between 2004 and 2009.
Scientists observed that more than a third of the study subjects required medication for hypertension or kidney disease about four years after they had joined the study.
The young patients were randomly placed in three groups and received either metformin (brand names Glucophage, Glucophage XR, Glumetza, Fortamet), metformin plus rosiglitazone (brand name for combination Avandamet), or metformin plus intensive lifestyle intervention.
Researchers noted that results from all three of these groups were dismaying. Dr. Lynch said that all groups performed poorly, although children on the combined drugs did the best of the three groups, reducing their need for insulin therapy.
The rate of deterioration of beta cell function in youth was almost four times higher than in adults, scientists found, noting a 20 to 35 percent decline in beta cell function per year on average, compared to 7 to 11 percent for adults. Beta cells store and release insulin.
Researchers underscored the alarming fact that all these young patients had met specific health criteria when they enrolled: They either did not have high blood pressure or they had treatable levels of high blood pressure. They all received the best possible care, education and medical support.
Participants also had to have a parent or guardian joining them in clinical visits and lifestyle education, and their medicine was paid for.
"That's Cadillac treatment for any kids with diabetes—and we still had these outcomes," said Dr. Lynch.
Despite the interventions in all three groups, the kids kept getting sicker.
Boys and girls both developed kidney disease at about the same rates, but obese teenage boys were 81 percent more likely to develop hypertension, Dr. Lynch noted.
Kathleen C. Moltz, MD, FAAP, is a pediatric endocrinologist on staff at Children's Hospital of Michigan and dailyRx Contributing Expert said, "The TODAY study confirms what has become clear to those of us in clinical medicine and clinical research - that type 2 diabetes mellitus in adolescents is increasing in incidence and is a much more aggressive disease than in adults."
She continued "There continue to be significant limitations in treatment regimes, in large part due to the limited testing and approval of medications for type 2 diabetes mellituss in non-adults. Additionally there is no opportunity to 'wait' until adulthood to treat this progressive disease and its complications - these teens are suffering from health deterioration from the time of diagnosis. The TODAY study underscores that further efforts are needed in providing treatment options for adolescents with type 2 diabetes mellitus."
"What's especially challenging for these children is that many also develop fatty liver, which limits our use of the drugs that control hypertension," she said.
The investigation will continue as researchers monitor the participants' overall outcomes, including cardiac health.
"Our goal is to follow them for 10 or 15 years as we figure out better ways to prevent this disease and how to predict complications," Dr. Lynch said.
The study was published online in May in Diabetes Care. The study was funded in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/National Institutes of Health (NIH).