Type 2 diabetes, the kind linked with obesity, progresses much faster and is harder to treat in children than in adults, according to the disappointing results of a new study that sought to determine the best treatment for the disease in obese teens.
The study, the largest to examine Type 2 diabetes treatment in youth, looked at the effectiveness of several methods to manage blood sugar in newly diagnosed teens aged 10 to 17. The researchers found that nearly half of all participants failed to maintain stable blood sugar over the four-year study, and 1 in 5 suffered serious complications as a result.
The findings are troubling for teens’ health since obesity and diabetes rates are increasing nationwide. Uncontrolled diabetes can increase the risk for serious health problems, including heart disease, vision loss, nerve problems, amputations and kidney failure.
Type 2 diabetes — once referred to as adult-onset diabetes — was rarely seen among children before the 1990s. But as American children and teens started getting fatter, related cases of diabetes began to rise. Today, Type 2 diabetes is still uncommon in children (Type 1, or juvenile, diabetes affects more youths), but the disease continues to increase at an alarming rate: between 2002 and 2005, there were about 3,600 new cases of Type 2 diabetes in children and teens a year.
For the new study, released Sunday by the New England Journal of Medicine, researchers followed 699 overweight and obese teens who had been recently diagnosed with diabetes. Most of the participants were from low-income families; 40% were Hispanic, 33% black, 20% white, 6% American Indian and fewer than 2% were Asian.
All of the participants were started off on metformin, the standard oral medication for Type 2 diabetes, to normalize their blood sugar levels. They were then divided into three treatment groups to maintain blood sugar control. One group continued to use metformin alone; another used metformin along with an intensive diet, exercise and weight-loss program; the third used metformin plus another drug, rosiglitazone (Avandia).
Failure rates were high for all three treatment groups. About half of the teens in the metformin group failed to keep their blood sugar down, 39% failed in the group using metformin plus Avandia, and 47% failed in the diet and exercise group.
“It’s frightening how severe this metabolic disease is in children,” study author Dr. David M. Nathan, director of the diabetes center at Massachusetts General Hospital, told the New York Times. “I fear that these children are going to become sick earlier in their lives than we’ve ever seen before.
The authors could only speculate why diabetes is so hard to treat in children and teens, but it could be due to rapid growth and hormonal changes during puberty.
So what can be done? Obviously, the best treatment is prevention: “Don’t get diabetes in the first place,” researcher Dr. Phil Zeitler of the University of Colorado Denver told the Associated Press.
However, it will take a concerted national effort to help keep children from the increasing risk. In an editorial accompanying the study, Dr. David Allen of the department of pediatrics at the University of Wisconsin School of Medicine and Public Health, in Madison, writes:
In terms of immediate treatment, when the usual drugs fail, daily insulin shots may be needed. The researchers note that adding Avandia to metformin is not recommended for children or teens because the drug has been linked to an increased risk of heart attack and stroke in adults, and the U.S. Food and Drug Administration has severely restricted its use. Other oral medications for diabetes haven’t been studied or approved for use in children.
“A single pill or single approach is not going to get the job done,” study author Dr. Mitchell Geffner of the Children’s Hospital Los Angeles told the AP.
Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier “eat less, move more” environment is created for today’s children, lifestyle interventions like that in the…study will fail.
The stark message from the…study is that, tomorrow and beyond, public-policy approaches — sufficient economic incentives to produce and purchase healthy foods and to build safe environments that require physical movement — and not simply the prescription of more and better pills will be necessary to stem the epidemic of type 2 diabetes and its associated morbidity.