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Glycemic control in youth with type 2 diabetes declines as early as two years after diagnosis

Lorraine E Levitt Katz1, Sheela Natesh Magge, Marcia L Hernandez

  • 1Division of Endocrinology and Diabetes, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. KatzL@email.chop.edu

The Journal of Pediatrics
|August 28, 2010
PubMed

Insights

Pediatric type 2 diabetes (T2DM) patients show increasing insulin needs over four years. Diabetic ketoacidosis at diagnosis indicates faster beta-cell decline in children with T2DM.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pediatric Diabetes

Background:

  • Type 2 diabetes mellitus (T2DM) is increasingly diagnosed in pediatric populations.
  • Understanding the natural history of T2DM in children is crucial for effective management.
  • Glycemic control and beta-cell function in pediatric T2DM are not well-characterized longitudinally.

Purpose of the Study:

  • To define the longitudinal changes in glycemic control (HbA1c) and insulin requirements in pediatric T2DM.
  • To assess changes in markers of insulin reserve, including fasting C-peptide and IGFBP-1, over time.
  • To compare these trajectories between children with and without diabetic ketoacidosis at diagnosis.

Main Methods:

  • A cohort of pediatric patients with T2DM was followed for 4 years.
  • Participants were divided into two groups: Nonacidotic T2DM (NA) and T2DM with diabetic ketoacidosis (DKA).
  • Measurements included HbA1c, insulin dose, fasting C-peptide, and IGFBP-1, collected at baseline and every 6 months.

Main Results:

  • The DKA group presented with higher HbA1c and insulin requirements, and lower C-peptide levels at baseline compared to the NA group.
  • HbA1c levels initially declined, reaching a nadir at 6-12 months, then began to rise after 1.5 years.
  • Insulin requirements decreased initially, reaching a nadir at 1 year, and subsequently increased over the following years.

Conclusions:

  • Children with T2DM exhibit a distinct pattern of increasing insulin requirements over a 4-year period, unlike adults.
  • Diabetic ketoacidosis at diagnosis is a predictor of more significant beta-cell decline in pediatric T2DM.
  • Longitudinal monitoring of glycemic markers and insulin reserve is essential for managing T2DM in children.
Abstract

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