Correlates of Treatment Patterns Among Youth With Type 2 Diabetes
Published Date:Sep 11 2013
Source:Diabetes Care. 2014; 37(1):64-72.
Pubmed Central ID:PMC3867996
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
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.
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).
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.
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