Glycemic control in youth‐onset type 2 diabetes correlates with weight loss

Abstract

Objective: To identify risk factors for glycemic failure in youth with type 2 diabetes (T2D). Methods: A retrospective review of HbA1c, anthropomorphic measures, medication records, and laboratory studies was performed using registry data from a dedicated pediatric T2D clinic. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years. Results: The registry includes 229 youth with T2D, of whom 80% self-identify as Latinx. The odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis correlated with diagnostic HbA1c, with OR of 2.41 if HbA1c at diagnosis >8.5% (sensitivity 68%, specificity 54%, P = .015). LPA modeling identified three HbA1c profiles: (a) mean HbA1c <8% throughout the 5 years, (b) persistent elevation of mean HbA1c >9%, and (c) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4 to 6 months, and increase to 11% by 18 months. Our analysis of medication regimen showed that, amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss over the 1 year after diagnosis correlated with improvement in HbA1c in both subjects prescribed metformin monotherapy, as well as insulin-containing regimen. Conclusion: Youth with T2D exhibit distinct HbA1c profiles. Patients with diagnostic HbA1c >8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Weight management has the potential to improve short-term HbA1c outcome in youth with T2D. Additional studies are needed to determine the role of medication adherence on glycemic control.

Impact of COVID-19 on Youth With Type 2 Diabetes: Lessons Learned From a Pediatric Endocrinologist and a Psychologist

“…A similar trend has been detected among people infected with COVID-19 (6,7). Many youth with T2D develop uncontrolled hyperglycemia 12 to 18 months after they are diagnosed with diabetes (8). In some reports, hyperglycemia in individuals with T2D is associated with increased COVID-19 disease severity and mortality (9,10).…”

Spike in Diabetic Ketoacidosis Rates in Pediatric Type 2 Diabetes During the COVID-19 Pandemic

“…The data review and analysis were in compliance with regulations set forth by the CHLA Institutional Review Board (Los Angeles, CA). Type 2 diabetes was diagnosed as previously described (10,11). The diagnosis of DKA was based on pH <7.3 and/or bicarbonate level <15 mmol/L.…”

The Impact of a Self-Management Program Based on the 5 A’s Model on Type 1 Diabetes in School-Aged Children

“…Diabetes type 1 is one of the most prevalent chronic health problems in children worldwide. Although the treatment of type 1 diabetes has changed a lot over the last few decades thanks to the success of intensive insulin therapy, insulin pumps, and continuous glucose moni-tors, many children still have trouble keeping their A1C levels at the right level and are more likely to have complications [4].…”

“…Type 1 diabetes occurs when the immune system, in response to an infection, attacks and destroys the pancreas' insulin-producing beta cells [3]. As a result, type 2 diabetes can be caused by a wide range of things, including lifestyle factors and genes like being overweight, being obese, and not being active [4].…”

“…Diabetes type 1 is one of the most common chronic diseases in children. However, most kids still cannot control their A1C levels within normal ranges and are more prone to complications [4] despite the fact that insulin pumps and CGMs have been around for a long time. The American Diabetes Association (ADA) stresses diabetes self-management education and support in current diabetes treatment guidelines [1].…”