Medication and HbA1c Control in Young Adults With Type 2 Diabetes

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The use of thiazolidinediones in young adults with type 2 diabetes had significantly decreased over time.
The use of thiazolidinediones in young adults with type 2 diabetes had significantly decreased over time.

The majority of young adults with youth-onset type 2 diabetes are being treated with insulin and/or metformin, and by 7 years after diagnosis, most do not achieve the American Diabetes Association recommended glycated hemoglobin (HbA1c) goal of below 7%, according to a study published in Pediatric Diabetes.

Despite the prevalence of youth-onset diabetes and the fact that there are 11 different classes of diabetes medications approved by the FDA (Food and Drug Administration) for adult use, metformin and insulin are the only 2 approved for children and adolescents with diabetes. 

This study expanded upon the national, population-based, multicenter SEARCH for Diabetes in Youth Study, which found that over 50% of youth with type 2 diabetes had HbA1c levels over 8% 2 years after diagnosis, to examine contemporary treatment patterns and HbA1c control over a longer follow-up period. SEARCH funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.

Cross-sectional analysis of 646 children and adolescents with type 2 diabetes confirmed most were treated with insulin and/or metformin. Of these patients, 322 were followed for a longitudinal analysis over 7 years, with only 35% showing HbA1c levels below 7% by 7-year follow up.

Study investigators conclude that the lack of adequate disease control in youth with type 2 diabetes indicates there is a need “to examine why so few medications have been approved for pediatric use: 75% of the currently completed randomized clinical controlled registration trials in pediatric patients have not resulted in approvals from the FDA, while ongoing clinical and translational research studies are facing significant recruitment challenges. Greater attention needs to be placed on addressing the challenges and approaches for developing new treatments for youth-onset diabetes so there are more therapeutic options available.”

Reference

Pinto CA, Stafford JM, Wang T, et al. Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth onset type 2 diabetes: the SEARCH for Diabetes in Youth Study [published online May 15, 2018]. Pediatr Diabetes. doi: 10.1111/pedi.12691

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