Study: 2 drugs is best for type 2 diabetes in youth

April 30, 2012, 8:16 a.m.

Metformin, which often comes in pill form, is the only FDA-approved treatment for type 2 diabetes in youth, but researchers have found that when used alone, it's not very effective. (Credit: Doug Wheller/Flickr Creative Commons)

Two drugs is better than one when it comes to treating youth with recent-onset type 2 diabetes.

A new study has found that combining two diabetes drugs – metformin and rosiglitazone – was more effective than just the metformin alone. It also found that the metformin alone was not effective, period, for many of the youth participating in the study.

Funded by the National Institutes of Health, the TODAY study (Treatment Options for type 2 Diabetes in Adolescents and Youth) was the first major examination of different treatments for the illness in young people. It appeared in the New England Journal of Medicine.

It looked at 669 youth between the ages of 10 to 17 with the disease and split them into three groups: one on metformin alone; another on metformin and rosiglitazone; and another on metformin with intense lifestyle changes – lifestyle, diet – in order to help the subject lose weight. Researchers were looking for what would work best in maintaining healthy and long-term blood glucose control.

They found that the metformin and rosiglitazone regimen was most effective, with a failure rate of only 38.6 percent, while the metformin alone and metformin plus the lifestyle changes failed 51.7 and 46.6 percent of the time, respectively.

"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 study chair Philip Zeitler in a statement. "We are learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly." He added that may be why the metformin alone failed at such a high rate.

The surge in childhood obesity has led to more cases of type 2 diabetes in youth, but the information on the disease in youth and how to treat it is much more limited than it is for adults. Metformin is currently the standard treatment, and the only one approved for use in treating youth by the Food and Drug Administration, but the study indicates that may not be the most effective tack.

One striking aspect of the study is that the physical activity in one of the control groups had no effect.

"Despite a rigorous lifestyle intervention, we were unable to achieve sustained lifestyle changes in these youth, though similar strategies have proven effective in adults," said Barbara Linder, the National Institute of Diabetes and Digestive and Kidney Diseases' senior advisor for childhood diabetes research.

South Los Angeles' child obesity rates approach county highs – the L.A. City Council's ninth district ranks a dismal 105th out of 119 areas measured for child obesity with a prevalence rate of 29.5 percent, according to the L.A. County Department of Public Health. In what is perhaps an indication of how little is known about diabetes in youth, the department had statistics about the disease in adults, but not for anyone below the ages of 18.

On top of this, the question of access to medical care remains – the area is akin to a "barren wasteland" when it comes to residents' having access to affordable primary and specialty care, according to Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics.

Even then, the southside's problem is much bigger than one disease, according to Nicole Vick, a health educator for the Area Health Office in the L.A. County Department of Public Health.

"I always say if you just target one disease, you don't deal with the issue," she told OnCentral in April. "You're working downstream trying to prevent diabetes, but you're not looking upstream at the fact that there aren't enough grocery stores in these neighborhoods."

Photo by Doug Wheller via Flickr Creative Commons.

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