Treatment adherence and BMI reduction are key predictors of HbA1c 1 year after diagnosis of childhood type 2 diabetes in the United Kingdom

Candler, Toby; Mahmoud, Osama; Lynn, Richard; Majbar, Abdalmonen A.; Barrett, Timothy; Shield, Julian P H

doi:10.1111/pedi.12761

Cited by 12 publications

(12 citation statements)

References 37 publications

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“…Though there are likely many contributions to this disparity, including both psychosocial and physiologic factors, medication adherence is a key determinant of treatment responsiveness in the pediatric population, as higher HbA1c and poorer glycemic control has been linked with reduced metformin adherence in adolescence 6 . Specifically, suboptimal metformin adherence in youth may be the result of two key factors: metformin is associated with high rates of gastrointestinal (GI) side effects, and when using the standard release (SR) formulation, the twice daily dosing may be associated with significant medication burden 7 .…”

Section: Introductionmentioning

confidence: 99%

Metformin treatment and gastrointestinal symptoms in youth: Findings from a large tertiary care referral center

et al. 2020

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Objectives Metformin is the only oral therapy for youth with type 2 diabetes, but up to 50% require additional agents within 2 years of diagnosis. Extended‐release (XR) metformin formulations may improve adherence and tolerability–important mediators of treatment response–but data in youth is lacking. To evaluate rates of gastrointestinal (GI) symptoms in patients treated with metformin (SR and XR) and the change in GI symptoms after changes in metformin therapy. Research Design and Methods Retrospective chart review of youth with Type 2 or prediabetes seen in a multidisciplinary clinic during 2016–2019. Results Of 488 eligible patients, 41.4% and 21.1% were taking metformin SR and XR respectively, with most (58%, n = 178/305) taking a total daily dose of ≥1500 mg/day. Those not on metformin tended to be younger, leaner, and had lower HbA1cs than those taking metformin, p < 0.05. Thirty percentage of patients described GI symptoms, most commonly, abdominal pain and diarrhea. There was no difference in GI symptoms in those on SR versus XR (18.3% vs. 14.6%, p = 0.41). Among patients who initiated metformin, rates of GI symptoms increased (13%–33%, p = 0.001, n = 99), while rates tended to decrease when metformin was discontinued (28%–12%, p = 0.076, n = 50). Rates of GI symptoms were unchanged among those that switched from SR to XR metformin (17% vs. 14%, p = 0.6, n = 58). Conclusions GI symptoms are common in youth with type 2 diabetes taking metformin XR and SR. Adjuncts to mitigate GI symptoms in youth on metformin therapy are needed to improve quality of life and medication adherence.

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Section: Introductionmentioning

confidence: 99%

Metformin treatment and gastrointestinal symptoms in youth: Findings from a large tertiary care referral center

et al. 2020

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“…Adherence is a crucial parameter of treatment success, considering there is evidence for a direct association between high adherence and better clinical outcomes (Candler et al, 2018;Matsuzawa et al, 2019). Adherence is a crucial parameter of treatment success, considering there is evidence for a direct association between high adherence and better clinical outcomes (Candler et al, 2018;Matsuzawa et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…In the present study, we will evaluate adherence to self‐control training as a marker of treatment feasibility, prior to evaluating its effects in a randomized controlled trial or an RCT (Naets et al, ). Adherence is a crucial parameter of treatment success, considering there is evidence for a direct association between high adherence and better clinical outcomes (Candler et al, ; Matsuzawa et al, ). It is recognized as a general threat in several nonpharmacological chronic disease interventions (Cheiloudaki & Alexopoulos, ; Dunbar‐Jacob & Mortimer‐Stephens, ).…”

Section: Introductionmentioning

confidence: 99%

Adherence and barriers in e‐health self‐control training for enhancing childhood multidisciplinary obesity treatment

Naets

Vervoort

Tanghe³

et al. 2019

Clin Psychology and Psychoth

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Training self-control as the assumed underlying mechanism for weight loss is a promising pathway for improving long-term outcomes of childhood multidisciplinary obesity treatment (MOT). The present study is the first to analyse adherence to ehealth self-control training in paediatric obesity. We hypothesized that low adherence would relate to child characteristics and to contextual treatment barriers. Participants were recruited as a part of a larger randomized controlled trial, evaluating an e-health self-control training during inpatient MOT (intensive phase) and its outpatient aftercare (booster phase). A number of 68 youngsters with severe obesity between 11 to 19 years old were included in the present study. Excellent adherence was observed in the intensive phase during inpatient MOT, but rates decreased in the booster phase. As predicted, the low adherence group had a significantly higher weight status throughout the entire study period. Differences in contextual treatment barriers did not appear. Further in-depth analysis showed that the low adherence group frequently experienced practical obstacles. The end of inpatient MOT and high weight status can be considered important risk factors for low adherence in an additional self-control training aimed at facilitating weight loss.

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“…6 More recently, Candler et al reported on the outcome from the British pediatric Surveillance Unit and identified weight loss as a predictor of improved glycemic control, which was not previously reported in the TODAY study. 17 It remains unclear if certain risk factors contributing to glycemic control are cohortspecific.…”

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confidence: 99%

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

et al. 2020

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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.

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Treatment adherence and BMI reduction are key predictors of HbA1c 1 year after diagnosis of childhood type 2 diabetes in the United Kingdom

Abstract: Adherence to treatment and a reduction in BMI appear key to better outcomes a year after T2DM diagnosis. Retention and clinic attendance are concerning. The prevalence of microalbuminuria has increased 4-fold in the year following diagnosis and was associated with higher HbA1c.

Cited by 12 publications

References 37 publications

Metformin treatment and gastrointestinal symptoms in youth: Findings from a large tertiary care referral center

Metformin treatment and gastrointestinal symptoms in youth: Findings from a large tertiary care referral center

Adherence and barriers in e‐health self‐control training for enhancing childhood multidisciplinary obesity treatment

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

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