Glycemic control and lipid outcomes in children and adolescents with type 2 diabetes
Mary Margaret Barr1, Stella Aslibekyan2, Ambika P Ashraf3
1University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
Insights
Pediatric type 2 diabetes (T2DM) management shows limited optimal glycemic control at 1 and 3 years. Insulin-based treatments showed some lipid and glycemic improvements, but further research is needed for better pediatric T2DM therapies.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Diseases
Background:
- The incidence of type 2 diabetes in children is rising dramatically.
- Limited data exists on glycemic control and lipid outcomes in pediatric T2DM outside clinical trials.
Purpose of the Study:
- To assess glycemic control and lipid measure outcomes at one and three-year follow-up in pediatric patients with type 2 diabetes.
Main Methods:
- Retrospective electronic medical record review of pediatric patients diagnosed with T2DM.
- Study conducted at the Children's Hospital of Alabama over a 12-year period.
- Analysis included 301 patients with 1-year follow-up and 184 with 3-year follow-up.
Main Results:
- At one year, 37% achieved optimal glycemic control (HbA1C ≤6.5%) and 58% achieved durable control (HbA1C ≤8%).
- Insulin-treated patients (alone or with metformin) showed improved lipid and glycemic outcomes.
- Significant improvements in non-HDL, HDL, and TC/HDL ratios were observed in patients treated with insulin and metformin.
Conclusions:
- A minority of pediatric T2DM patients achieve optimal glycemic control with current treatments.
- Further studies are needed to determine optimal therapeutic strategies for managing pediatric T2DM.
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.
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