Type 2 diabetes is harder to treat in children ages 10 to 17 than it is in adults, according to one of the first large studies of the disease in younger people.
The research also found that diabetes develops more rapidly in this age group. About 700 overweight and obese U.S. children and teens were given three therapies in the study: The oral drug metformin alone; that medicine combined with GlaxoSmithKline Plc’s Avandia; and metformin used alone with diet and exercise.
All three had high failure rates, according to the results published in the New England Journal of Medicine. The data is key as the number of overweight children in the U.S. has tripled since 1980, spurring a concurrent rise in Type 2 diabetes, according to the U.S. Centers for Disease Control and Prevention in Atlanta. About 3,600 new cases are diagnosed in children yearly, the researchers reported.
“With diabetes developing younger in life, it means people now have the disease for a longer period and will move onto more intensive and expensive therapy earlier, and require it longer,” said Timothy Gill of the University of Sydney, in an e-mail. “These implications may be magnified by the more severe form of diabetes that appears to develop in adolescents and young adults. There are enormous public health consequences.”
Gill, who is principal research fellow at the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, wasn’t involved in the latest research.
The study, which ran for four years, found that 52 percent of those using metformin alone had treatment failure, forcing them to undergo daily shots of insulin to control their blood sugar. Metformin combined with lifestyle changes didn’t significantly improve blood-sugar rates and only about a third of the patients gained the targeted weight loss.
Use of Avandia with metformin was the most effective therapy, though that too failed in 39 percent of the children and teenagers, according to the data.
The results “imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a few years after diagnosis,” wrote David B. Allan, at the University of Wisconsin School of Medicine and Public Health in Madison, in an accompanying editorial.
The failure rate with metformin alone appeared higher among children than it is in some adult patients, Allan wrote. The report didn’t say why Type 2 diabetes is harder to treat in children, though the researchers suggested the normal growth cycle may be at least partly at fault.
The research was led by Phil Zeitler, at the University of Colorado Denver, and Kathryn Hirst and Laura Pyle at George Washington University in Washington. It was funded by the U.S. National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, among other groups.
“This study highlights some of the real challenges posed in managing young people affected by type 2 diabetes,” said Louise Baur, a professor of pediatrics at the University of Sydney, in an e-mail. “Lifestyle change is difficult, and families and young people need a great deal of support to do so. And the study also shows that medications aren’t a panacea.”
Baur, who is on the editorial board of the International Journal of Pediatric Obesity, wasn’t involved in the research.
Diabetes can lead to heart disease and other medical ailments later in life. With Type 2 diabetes, fat, liver, and muscle cells become resistant to insulin. As a result, blood sugar doesn’t get into these cells to be stored for energy, building up instead in the blood.
Prevention the Solution
People who develop Type 2 diabetes as children are more susceptible to increased blood-cholesterol and triglycerides, which are risk factors for cardiovascular disease, said Paul Zimmet, honorary president of the Brussels-based International Diabetes Federation, who has studied the disease for 40 years.
“We don’t have a solution to this except to do better things about prevention,” said Zimmet, who wasn’t involved in the research. The data supports what physicians have seen in their offices, he said, adding “it’s typically more difficult to achieve desirable blood-sugar control in children and adolescents than it is adults.”
One key issue is treatment compliance, he said,
“Adults may understand better that this is a life-long disease,” Zimmet said in a telephone interview. “It’s very hard to tell a 12-year-old that they’re going to be on medication for the rest of their life.”