Glycemic control and lipid outcomes in children and adolescents with type 2 diabetes

Abstract

Background The incidence of type 2 diabetes (T2DM) in children has increased dramatically. However, limited published information is known about the glycemic control and lipid outcomes in pediatric T2DM outside of clinical trials. Objectives To determine the glycemic control and lipid measure outcomes at one and three- year follow-up in children with T2DM. Methods A retrospective electronic medical record review of children with T2DM at the Children’s Hospital of Alabama over a 12-year period. Results There were 301 patients with a diagnosis of T2DM who had a 1-year follow-up visit, of which 184 also had a 3-year follow-up. Most patients (78%) received either insulin with metformin or insulin alone at diagnosis. At one year, 37% of the cohort achieved ‘optimal glycemic control’ (HbA1C ≤6.5%) and 58% of patients achieved durable glycemic control (HbA1C ≤8%). Optimal glycemic control was seen in 48 patients at 3 years. The patients treated with insulin (alone or in combination with metformin) tended to have higher HbA1C at diagnosis, but had improved lipid and glycemic outcomes at follow-up. The group treated with insulin along with metformin had significant improvements in non-HDL, HDL and TC/HDL ratios. The effects of insulin treatment on glycemic control at 3 years were not statistically significant. Conclusion With the current modality of treatment, only a minority of patients achieve optimal glycemic control at 1 and 3 years of follow-up. Studies are warranted to further elucidate the optimal therapies in the management of pediatric T2DM.

Trajectories in glycated hemoglobin and body mass index in children and adolescents with diabetes using the common data model

“…More than half of the T2D patients failed to achieve the glycemic target after 5 years, comparable with previous studies 23 , 24 . Several studies have evaluated real-world longitudinal trends in the HbA1c level in youth with T2D 23 – 26 , and reported worsening of glycemic control from 1 to 1.5 years after diagnosis 25 , 26 .…”

Dyslipidemia in Pediatric Type 2 Diabetes Mellitus

“…A phase 2 trial of IONIS-ANGPTL3-L Rx (this acts primarily within hepatocytes to block production of hepatic ANGPTL3) in patients with T2D, hepatosteatosis, and TG > 200 mg/dL is underway (NCT03371355) in adults. Some of the ongoing clinical trials aim to test newer medications whose primary outcome is improving glycemic control in pediatric patients, with dyslipidemia being studied as a secondary outcome of the study get another ongoing studies include clinical trials on the safety and efficacy of ertugliflosin, an SGLT-2 inhibitor (NCT04029480), a [82,83] ↓ ↑ ↓ Mostly cohort studies with short term data Insulin [52,53,84] ↓ ↑ ↔ Significant when A1C ≤ 8% Metformin [52,53,84,85] ↓ Mild ↑ ↓ TODAY study: 55.9% of the youth remained at the LDL-C goal of < 100 mg/dL over the first 3 years. Levels of TG, apo B, and non-HDL-C rose from baseline to the end of the first year and remained at a higher level for the next 2 years.…”

Dietary Patterns, Blood Pressure and the Glycemic and Lipidemic Profile of Two Teenage, European Populations

“…Consumption of energy-dense foods in children and teenagers with a family history of type 2 diabetes, plays a central role in the formation of a worse glycemic profile and potentially, subsequent development of type 2 diabetes (T2D) [ 16 ]. T2D in children is associated with a deteriorated lipidemic profile (i.e., dyslipidemia), as a direct effect of the observed insulin resistance [ 17 ]. A different study showed that Greek children with dyslipidemia and unfavourable dietary habits, such as consuming only one meal per day, displayed higher levels of various biomarkers of lipidemic control, namely total cholesterol and low-density lipoprotein cholesterol (LDL-C) [ 18 ].…”