Correlates of Treatment Patterns Among Youth With Type 2 Diabetes

Details

• Alternative Title:
  Diabetes Care
• Personal Author:
  Badaru, Angela ; Klingensmith, Georgeanna J. ; Dabelea, Dana ; Mayer-Davis, Elizabeth J. ; Dolan, Lawrence ; Lawrence, Jean M. ; Marcovina, Santica ; Beavers, Daniel ; Rodriguez, Beatriz L. ; Imperatore, Giuseppina ; Pihoker, Catherine
• Description:
  OBJECTIVE
  
  To describe treatment regimens in youth with type 2 diabetes and examine associations between regimens, demographic and clinical characteristics, and glycemic control.
  
  RESEARCH DESIGN AND METHODS
  
  This report includes 474 youth with a clinical diagnosis of type 2 diabetes who completed a SEARCH for Diabetes in Youth study visit. Diabetes treatment regimen was categorized as lifestyle alone, metformin monotherapy, any oral hypoglycemic agent (OHA) other than metformin or two or more OHAs, insulin monotherapy, and insulin plus any OHA(s). Association of treatment with demographic and clinical characteristics (fasting C-peptide [FCP], diabetes duration, and self-monitoring of blood glucose [SMBG]), and A1C was assessed by χ2 and ANOVA. Multiple linear regression models were used to evaluate independent associations of treatment regimens and A1C, adjusting for demographics, diabetes duration, FCP, and SMBG.
  
  RESULTS
  
  Over 50% of participants reported treatment with metformin alone or lifestyle. Of the autoantibody-negative youth, 40% were on metformin alone, while 33% were on insulin-containing regimens. Participants on metformin alone had a lower A1C (7.0 ± 2.0%, 53 ± 22 mmol/mol) than those on insulin alone (9.2 ± 2.7%, 77 ± 30 mmol/mol) or insulin plus OHA (8.6 ± 2.6%, 70 ± 28 mmol/mol) (P < 0.001). These differences remained significant after adjustment (7.5 ± 0.3%, 58 ± 3 mmol/mol; 9.1 ± 0.4%, 76 ± 4 mmol/mol; and 8.6 ± 0.4%, 70 ± 4 mmol/mol) (P < 0.001) and were more striking in those with diabetes for ≥2 years (7.9 ± 2.8, 9.9 ± 2.8, and 9.8 ± 2.6%). Over one-half of those on insulin-containing therapies still experience treatment failure (A1C ≥8%, 64 mmol/mol).
  
  CONCLUSIONS
  
  Approximately half of youth with type 2 diabetes were managed with lifestyle or metformin alone and had better glycemic control than individuals using other therapies. Those with longer diabetes duration in particular commonly experienced treatment failures, and more effective management strategies are needed.
  
  
• Subjects:
  Administration, Oral Adolescent Blood Glucose Blood Glucose Self-Monitoring C-Peptide Child Clinical Care/Education/Nutrition/Psychosocial Research Diabetes Mellitus, Type 2 Female Hemoglobin A, Glycosylated Humans Hypoglycemic Agents Insulin Life Style Male Metformin Treatment Failure Young Adult

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• Source:
  Diabetes Care. 2014; 37(1):64-72.
• Pubmed ID:
  24026554
• Pubmed Central ID:
  PMC3867996
• Document Type:
  Journal Article
• Funding:
  1U18DP002709/DP/NCCDPHP CDC HHS/United States ; 1UL1RR026314-01/RR/NCRR NIH HHS/United States ; M01 RR00069/RR/NCRR NIH HHS/United States ; P30 DK57516/DK/NIDDK NIH HHS/United States ; U01 DP000244/DP/NCCDPHP CDC HHS/United States ; U01 DP000245/DP/NCCDPHP CDC HHS/United States ; U01 DP000246/DP/NCCDPHP CDC HHS/United States ; U01 DP000247/DP/NCCDPHP CDC HHS/United States ; U01 DP000248/DP/NCCDPHP CDC HHS/United States ; U01 DP000250/DP/NCCDPHP CDC HHS/United States ; U01 DP000254/DP/NCCDPHP CDC HHS/United States ; U18DP000247-06A1/DP/NCCDPHP CDC HHS/United States ; U18DP002708-01/DP/NCCDPHP CDC HHS/United States ; U18DP002710-01/DP/NCCDPHP CDC HHS/United States ; U18DP002714/DP/NCCDPHP CDC HHS/United States ; U48/CCU419249/PHS HHS/United States ; U48/CCU519239/PHS HHS/United States ; U48/CCU819241-3/PHS HHS/United States ; U48/CCU919219/PHS HHS/United States ; U58/CCU019235-4/PHS HHS/United States ; U58CCU919256/PHS HHS/United States ; UL1 RR029882/RR/NCRR NIH HHS/United States ; UL1RR029882/RR/NCRR NIH HHS/United States
• Volume:
  37
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6b892ee6ea561933806ddd73874c5558bb4d0c04b011e9dafa5a1ffcaf26e898
• Download URL:
  https://stacks.cdc.gov/view/cdc/27867/cdc_27867_DS1.pdf
• File Type:
  [PDF - 500.23 KB ]