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Specific treatments needed for type 2 adolescents, study finds

Specific treatments are needed for adolescents with type 2 diabetes, according to new research.
The study, known as the Treatment Options for Type 2 Diabetes in Youth study (TODAY), found that young people with type 2 diabetes who have an HbA1c level above 45.4mmol/mol (6.3 per cent) three months after starting to take metformin are four times more likely to lose control of their blood glucose levels.
The researchers assigned adolescents with type 2 diabetes randomly into one of three groups. The first group was treated with metformin alone, the second was treated with a combination of metformin and rosiglitazone, and the third was treated with metformin plus intensive lifestyle interventions.
The first group, which was treated using only metformin, failed to gain control of their blood glucose levels in 50 per cent of cases. This is a much lower success rate than that of adults, suggesting that more specialised treatments are needed for adolescents with type 2 diabetes.
However, 50 per cent of participants successfully gained control of their blood glucose levels regardless of how they were treated, suggesting that adolescents with type 2 diabetes can be split roughly into two groups: one of which needs specialised, intensive therapy to maintain blood glucose levels; one that doesn’t.
It might be possible to predict which type 2 adolescents need intensive therapy and which ones don’t, according to subsequent analyses conducted by the researchers. Using HbA1c levels, they were able to categorise participants with an HbA1c level of 45.4mmol/mol (6.3 per cent) or higher as needing intensive therapy. However, this is lower than the general target for people with diabetes. In adults, 45.4mmol/mol would be considered tight blood glucose control.
“These results already have changed my own clinical practice when caring for youth who have [HbA1c] values that are ‘in target’ but above the cutoff we’ve identified,” said Phil Zeitler, MD, PhD, study chair for the TODAY study, chair of the Department of Endocrinology, Children’s Hospital Colorado, and professor and head of the Section of Endocrinology, Department of Pediatrics, University of Colarado School of Medicine. “With the current results, I am much more likely to recommend intensification of therapy among youth in this population group who have not attained a non-diabetic [HbA1c], even if they have reached targets generally recommended for adults.”

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