Why might type 2 diabetes in youth have such a poor trajectory?
Comment on: TODAY2 confirms steep type 2 diabetes trajectory in youth
The TODAY2 findings are in line with those from the previously reported RISE trial in youth with type 2 diabetes, which showed that intensive medication did not slow the deterioration in beta cell function, contrary to previous research and the RISE adult medication study, reported at this year’s ADA Scientific Sessions.
Addressing the possible physiological factors that could underlie this disparity, TODAY2 researcher Philip Zeitler (University of Colorado, Aurora, USA) stressed to medwireNews that youths with type 2 diabetes “appear to be hypersecreting, even for whatever degree of insulin sensitivity they have.”
“So that seems to be something quite unique to these kids,” he said. “Why do they hypersecrete relative to their degree of insulin sensitivity and does that put them at greater risk for more rapid progression? I think that’s a question that we need to really understand.”
He said: “I think there’s two big buckets of possible explanations here. One is that developing diabetes during puberty is somehow more deleterious – it’s worse for your beta cells to get this problem while you have puberty.”
This is because insulin resistance markedly increases during puberty, already stressing the beta cells before diabetes is added on top.
“The other possibility is what I think about as ‘the slowest gazelle in the herd,’” said Zeitler. “So the kids who develop diabetes under the stress of puberty are the ones who are the weakest, whether it’s because of their beta cells or because they hypersecrete or whatever – they’re being picked out by the toxic environment at that point.”