Fida Bacha1, Peiyao Cheng2, Robin L Gal2, Craig Kollman2, William V Tamborlane3, Georgeanna J Klingensmith4, Katherine Manseau4, Jamie Wood5, Roy W Beck2. 1. Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. 2. Jaeb Center for Health Research, Tampa, Florida, USA. 3. Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA. 4. Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA. 5. University Hospital Cleveland Medical Center, Cleveland, Ohio, USA.
Abstract
BACKGROUND/AIMS: Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis. METHODS: Enrollment data from the Pediatric Diabetes Consortium T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared. RESULTS: At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA1c (9.9% [85 mmol/mol] vs. 5.9% [41 mmol/mol], p < 0.001). Lower HbA1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA1c trajectory after diagnosis was worse in group 2. CONCLUSION: Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.
BACKGROUND/AIMS: Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis. METHODS: Enrollment data from the Pediatric Diabetes Consortium T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared. RESULTS: At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA1c (9.9% [85 mmol/mol] vs. 5.9% [41 mmol/mol], p < 0.001). Lower HbA1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA1c trajectory after diagnosis was worse in group 2. CONCLUSION: Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.
Authors: Fida Bacha; Laure El Ghormli; Silva Arslanian; Philip Zeitler; Lori M Laffel; Lorraine E Levitt Katz; Rachelle Gandica; Nancy T Chang; Jennifer E Sprague; Sarah A Macleish Journal: Pediatr Diabetes Date: 2019-08-27 Impact factor: 4.866
Authors: Mary Ellen Vajravelu; Talia A Hitt; Sandra Amaral; Lorraine E Levitt Katz; Joyce M Lee; Andrea Kelly Journal: Pediatr Diabetes Date: 2021-06-30 Impact factor: 3.409
Authors: Julia Hudnut-Beumler; Jill L Kaar; Anya Taylor; Megan M Kelsey; Kristen J Nadeau; Philip Zeitler; Janet Snell-Bergeon; Laura Pyle; Melanie Cree-Green Journal: Pediatr Diabetes Date: 2021-04-27 Impact factor: 3.409
Authors: Ida Pastore; Andrea Mario Bolla; Laura Montefusco; Maria Elena Lunati; Antonio Rossi; Emma Assi; Gian Vincenzo Zuccotti; Paolo Fiorina Journal: Int J Mol Sci Date: 2020-07-12 Impact factor: 5.923