Youth-onset Type 2 Diabetes Research Articles

Clinical trials in youth-onset type 2 diabetes: needs, barriers, and options.

Youth-onset type 2 diabetes (T2D) is increasingly recognized as a disorder with substantial risk for long-term metabolic, cardiovascular, and renal morbidity and mortality, as well as individual and societal burden. Recent studies suggest that the disorder differs from adult-onset T2D in a variety of ways and that there is an urgent need for an expanded set of treatment options. However, demographic, economic, and social challenges limit the number of eligible candidates for clinical trials in youth-onset T2D, and a growing number trials mandated by regulatory agencies have created a circumstance in which too many trials are chasing too few eligible participants. A solution to this situation will require novel approaches to clinical trial design incorporating collaboration among clinical investigators, pharmaceutical sponsors, and regulatory agencies. If successful, this approach could also serve as a model for clinical trials in other rare and understudied pediatric disorders.

The future of treating youth-onset type 2 diabetes: focusing upstream and extending our influence into community environments.

Type 2 diabetes (T2D) in youth is on the rise and many of these youth already have comorbidity at disease onset. The TODAY trial clearly demonstrated the challenges of treating this disease. Obesity is a key risk factor in the development of youth-onset T2D, and its prevention can mitigate the risk for developing T2D. However, childhood obesity prevention efforts to date have shown only modest effectiveness. Considering the larger, complex socioeconomic and cultural contexts that influence health behaviors among children and their families can enhance prevention efforts. Community-based participatory, multi-component, multi-setting childhood obesity prevention initiatives designed using the socio-ecological model and systems theory have been effective in sustainably decreasing childhood overweight and obesity. To advance our progress in treating and preventing T2D in youth, we must apply this new knowledge on community-wide childhood obesity prevention to enhance the impact of individual-level therapeutic strategies such as the TODAY intervention.

Which obese youth are at increased risk for type 2 diabetes? Latent class analysis and comparison with diabetic youth

Most obese youth screened for diabetes have normal fasting glucose levels. Identification of youth with increased risk for type 2 diabetes (T2D) is needed within this large population to guide further management. Retrospective chart review was performed for obese youth, 8-20 yr old, who met American Diabetes Association criteria for screening (OB) or had T2D (D). Measures included body mass index z-score (BMIz) and homeostasis model assessment of insulin resistance (HOMA-IR) by fasting plasma glucose (FPG) and insulin. Statistics compared OB with D and further examined OB by latent class analysis (LCA). Normal FPG was found in 91.5% of all obese youth (OBt n = 94) Comparison of OB with normal FPG (OBng; n = 86) and D (n = 44) was significant for family history of T2D (p = 0.008) without other associations. Evaluation of OBng by LCA showed three classes with increasing BMIz and HOMA-IR. Class 3 (32.5%; BMIz 2.66 ± 0.38; HOMA-IR 6.72 ± 2.29) differed from classes 1 and 2 (p < 0.05), and was associated with family history of T2D. Currently recommended screening of obese youth by FPG is normal in 91.5%, but lacks further information to detect increased risk for youth-onset T2D. Evaluation of obese youth by LCA identified one third (class 3) in whom the combination of higher levels of BMIz, HOMA-IR, and family history suggests the greatest risk for T2D and targets them for further evaluation and intensive preventative management.