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Congress report: 72nd American Diabetes Association meeting

Congress report: 72nd American Diabetes Association meeting
  • Endocrinology and metabolism
  • Diabetes

Prof Chaicharn Deerochanawong reports from the 72nd American Diabetes Association meeting

One of the highlights from the American Diabetes Association’s 72nd Scientific Sessions meeting this year was new information on the rise of type 1 and type 2 diabetes in adolescents. Along with these alarming results, it was also evident that type 2 diabetes behaves more aggressively in adolescents than in adults with the same disease. This suggests that young individuals with diabetes will most likely encounter serious complications much earlier in life.

The SEARCH Trial, the first analysis of diabetes trends among American youth, demonstrated that in the past decade, there has been a significant rise in the prevalence of type 1 and type 2 diabetes in adolescents and that related complications, such as nerve damage and early indicators of kidney and heart disease, are already emerging in this population. This emphasizes the critical need to reverse this trend. The prevalence of type 2 diabetes increased 21 percent among American youth between 2001 and 2009, while type 1 diabetes rose to 23 percent. The data suggest that there were nearly 189,000 Americans under the age of 20 with diabetes; of those, 168,000 had type 1 and more than 19,000 had type 2.

Researchers believe that increasing obesity rates are at least a partial factor in the rise in type 2 diabetes among youth; the rise in prevalence of type 1 is, however, less easily explained. Researchers are currently investigating several theories.

The TODAY Study, the largest and only longitudinal study to look at the efficacy and safety of medications to treat young people with type 2 diabetes, resulted in children with type 2 exhibiting a higher rate of early complications and a relatively early need for combination therapy or insulin.

But there was also some positive news: researchers found that those who had good glycemic control (as evidenced by A1C levels in the normal range) after two to four months on metformin during the pre- randomization period were more likely to maintain that control for at least 48 months than those whose A1C levels were greater than 6.1 percent after the first few months of treatment on metformin. This suggests that some children (about half in the study), at least, can be successfully treated with a known therapy. More research is needed to determine the best treatment for the other 50 percent whose metformin therapy was insufficient for maintaining glycemic control.

The TODAY Study results emphasize the critical need for new treatments for youth by revealing the high rate of co-morbidities that manifest within a relatively short duration of living with the disease. Nearly one-third of the children in the study exhibited high blood pressure by the end of the study’s mean follow-up of just under four years (compared to just 12 percent at the beginning of the study); and close to 17 percent exhibited elevated urinary albumin levels (up from six percent at the beginning of the study). Roughly 13 percent of those in the study exhibited signs of eye disease which is relatively high after such a short duration of disease.

Another highlight was the presentation of several studies that addressed the safety of long-term use of insulin, a topic that had been highly debated in recent years. But the Origin study showed that there is no increased risk of heart attacks, strokes, cancer or cardiovascular-related deaths from taking insulin glargine as compared to not taking insulin. Not only that, but insulin therapy may delay type 2 diabetes in high-risk patients. In contrast to some earlier controversial studies, additional analyses of large databases from both Northern Europe and the U.S. showed no increase in cancer risk in patients who took insulin glargine compared to those who took other types of insulin.

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