Insulin, metformin remain most used treatments for type 2 diabetes in youths
medwireNews: The majority of adolescents and young adults with type 2 diabetes are still being treated with metformin and/or insulin, despite a growing number of medications being available for adults, US study data show.
Dana Dabelea (University of Colorado Denver, Aurora) and colleagues explain that there are currently 11 different classes of medications approved for use in adults with type 2 diabetes, but only two – insulin and metformin – approved for use in children and adolescents with the same condition.
Based on their findings the researchers say: “Greater attention needs to be placed on addressing the challenges and approaches for developing new treatments for youth-onset diabetes so there are more therapeutic options available.”
Using data for 646 participants in the SEARCH for Diabetes in Youth Study, who were all aged 20 years or younger at diagnosis, the team found that the majority of individuals were using metformin (64.9%) and/or insulin (38.1%) during the period 2002–2005.
These proportions did not change significantly in an analysis combining data for 2008 and 2012, with 70.4% using metformin and 38.4% using insulin.
The rate of sulfonylurea use also remained relatively stable, at 5.6% and 3.6% for each respective time period, but there was a significant reduction in thiazolidinedione use from 5.0% in 2002–2005 to 2.0% in 2008/2012.
This reduction reflects “a similar pattern observed in adults, which may be attributed to an increased awareness of safety concerns reported for adults in association with the use of this medication class,” Dabelea et al remark.
A longitudinal analysis of 332 participants who were followed up for a median 7 years after their diagnosis showed that significantly more participants changed medication from baseline to follow-up than remained on the same medication they were on at baseline, but the changes still largely involved metformin or insulin.
Indeed, only 15.9% of baseline metformin-only users and 6.5% of baseline insulin-only users were using an oral diabetes medication (ODM) other than metformin at follow-up, while 26.8% and 10.9%, respectively reported using lifestyle control methods only.
In addition, just 35% of participants had a glycated hemoglobin level below the 7.0% (53 mmol/mol) target at follow-up.
Writing in Pediatric Diabetes, Dabelea and co-authors say this finding provides “further evidence that a large proportion of children and adolescents with youth onset diabetes are not being treated to goal, which is of significant concern given the increased risk of vascular complications.”
The add: “Although the reasons for poor glycemic control were not evaluated in the current study, it should be noted that a majority of participants in the longitudinal cohort study were adults at the time of follow-up, yet there was very limited use of medications approved for adults other than metformin and/or insulin.”
The team concludes that “a lack of tailored clinical programs and policies to support transitioning of care for pediatric patients and loss to the healthcare system,” could partially explain their findings.
By Laura Cowen
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