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Prevalence, treatment of diabetes in young people eyed.

NEW YORK -- A combination of two diabetes drags, metformin and rosiglitazone, was more effective in treating youth with recent-onset type 2 diabetes than metformin alone, a study funded by the National Institutes of Health (NIH) has found.

Adding an intensive lifestyle intervention to metformin provided no more benefit than metformin therapy alone. The study also found that metformin therapy alone was not an effective treatment for many of these youth; in fact, metformin had a significantly higher failure rate in study participants than has been reported in studies of adults treated with metformin alone.

The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study is the first major comparative-effectiveness trial for the treatment of type 2 diabetes in young people. The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of NIH.

"The results of this study tell us it might be good to start with a more aggressive drug treatment approach in youth with type 2 diabetes," said Philip Zeitler, study chair and a pediatric endocrinologist at Children's Hospital Colorado. "We are learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly, which could be why metformin alone had a higher-than-expected failure rate."

Meanwhile, another study shows how diabetes and prediahetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008.

These findings, reported in the journal Pediatrics, are "very concerning," says lead author Ashleigh May, an epidemiologist with the Centers for Disease Control and Prevention (CDC).

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb, former president of medicine and science for the American Diabetes Association.

The TODAY study tested how well and for how long each of three treatment approaches controlled blood glucose levels in youth enrolled from ages 10 to 17 with type 2 diabetes. Participants were randomly assigned to one of three treatment groups: metformin alone, metformin and rosiglitazone together, and metformin plus intensive lifestyle changes aimed at helping participants lose weight and increase physical activity.

The study found that treatment with metformin alone was inadequate for maintaining acceptable, long-term, blood glucose control in 51.7% of youth 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 childhood obesity epidemic has led to more incidences of type 2 diabetes in youth. Because type 2 diabetes has been primarily an adult illness, information about how to treat youth effectively is limited.

Currently, metformin is the standard treatment for young people with type 2 diabetes and the only oral drug approved for this use by the Food and Drug Administration.

In the CDC research, May and her colleagues examined health data on about 3,400 adolescents ages 12 to 19 from 1999 through 2008. They participated in the CDC's National Health and Nutrition Examination Survey, considered the gold standard for evaluating health because it includes a detailed physical examination, taking participants' blood pressure and getting fasting blood sugar levels. Weight and height also are measured.

May notes that the diabetes findings should be considered with caution because the fasting blood glucose test was used and there are disadvantages associated with the test. Instead, many physicians use the A1c test, which examines a person's average blood sugar levels for the past three months.

"I wouldn't be surprised if prediabetes and diabetes went up some, but how much it may have gone up is still an open question because of the way they measured it," says Stephen Daniels, chairman of the department of pediatrics at the University of Colorado School of Medicine and a spokesman for the American Heart Association.

Still, about a third of U.S. adolescents are overweight or obese, which increases their risk of high blood pressure, type 2 diabetes and other health problems.
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Title Annotation:RX/Diabetes Care
Publication:Chain Drug Review
Date:Jun 11, 2012
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