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While more and more children are diagnosed with type 2 diabetes – a disease that in the past was an adult disease – a new study found that drugs used to treat adults are not effective to slow the progression of the disease.
The study, conducted by a Seattle professor, examined children aged 10-19 in two groups: children with pre-diabetic blood glucose levels and those with type 2 diabetes onset recent.
The researchers found that in young people treated with long-acting insulin followed by metformin, and in a separate group receiving metformin alone, none of these approaches preserved the body's ability to produce insulin. The drugs also did not slow the progression of type 2 diabetes.
"These results tell us that the treatments that work on adults and that we currently use for type 2 diabetes in young people are not as effective as we would like them to be," said Dr. Steven Kahn, a professor at the University of Ottawa. University of Washington. an endocrinologist at VA Puget Sound Health Care.
"We need to develop new approaches to treating adolescents with the disease."
Kahn chairs the national study and runs the Seattle site. The researchers say that it is clear from this and other studies that type 2 diabetes in young people is more aggressive than in adults.
For people with diabetes, the body does not do enough or uses insulin properly, a hormone that turns food into energy. It has two main forms: Type 1 and Type 2.
Type 1 diabetes, formerly known as juvenile diabetes, is an autoimmune disease that triggers the attack of beta cells of the pancreas by the body, so that the body produces little or no insulin .
Formerly known as adult diabetes, type 2 diabetes is the most common form and occurs when blood sugar is too high and the body does not produce enough insulin or does not use it well. insulin to counteract it. Too much glucose remains in the blood, and not enough reaches the cells. This is often badociated with obesity.
The more a person has type 2 diabetes, the greater the likelihood of developing heart, kidney, eye and nerve diseases. Because it has long been an adult condition, pediatric diabetes experts have had to rely on best practices for adult treatments, researchers say.
This study raises questions about why drugs that slow progression in adults do not have the same effect on young people, said Lisa Randall, Inland Northwest Health Services-certified diabetes educator.
Randall, who read the results of the study, noted that part of the study focused on prediabetic children and that the drugs could delay the onset of the disease, as in pre-diabetic adults.
"Basically, what they found was that it does not work as well," she said. "What we know about children and type 2 diabetes for some time now is that they are progressing very quickly toward type 2 diabetes, whereas in an adult, it can be two to 20 years. I am curious to know why this happens so quickly in children.
"What's happening is that these kids are very insulin-resistant – they make a ton of insulin, but it does not work."
Giving insulin and oral medications to adults often works effectively by removing the burden of beta cells to produce all that insulin, she said.
Youth from four study sites were randomly badigned to one of two treatment groups. The first received three months of insulin glargine followed by nine months of metformin. The second group only received metformin for 12 months. All were followed for three months after the end of treatment.
"If we receive an adult who has prediabetes or who has just been diagnosed type 2, and we give him insulin and / or metformin, they respond by improving the results for years." "said Randall. Children treated with both insulin and metformin and those under menformine alone have not seen, she added, "an impact on the improvement of beta cell function." Is the problem.The improvement of beta cell function or at least the stop of beta cell destruction is the way we prevent the progression of prediabetes to diabetes. "
However, she said with medicines for children and adults, "really the most powerful treatment we have is exercise."
The trials are among the first to compare young people with type 2 diabetes to their adult counterparts to see if early and aggressive treatment would improve outcomes.
Kahn said the pediatric study found that beta – key function of the body 's ability to make and release insulin – decreased in both groups and worsened after the end of the treatment. Both drugs reviewed are the only FDA approved for children.
"These studies provide essential new information that helps us better understand why type 2 diabetes appears to be progressing faster in young people," Kahn said. "This is an important news considering the growing epidemic of this disease in young people previously unaffected by type 2 diabetes.
"What is becoming more and more scary is that the number of children who have this disease is increasing."
About 193,000 Americans under the age of 20 are diagnosed with diabetes. The prevalence of type 2 diabetes among youth from 2000 to 2009 jumped by more than 30% to reach a rate of 2.3 patients per 5,000 children, according to a 2014 national study.
It is generally higher among racial and ethnic minority groups such as Native Americans and Native Americans in Alaska, Kahn said. He cites the need for a national push to overcome obesity.
Kahn said parents and doctors need to make sure that children with type 2 diabetes continue to use one or both drugs, "or that they're likely to progress faster."
"The first message is because your child has type 2 diabetes, it's not hopeless or lost," Kahn said. "The most important problem is the social issue, obesity is a major factor in the problem."
A push towards more nutritious foods – while moving away from laden dishes with calories – has to start at home and reach a national scene. And, "we must increase physical activity."
Other research is needed, added Kahn, including the effects of hormones during puberty. Other drugs are available for adults but not yet tested for children. He stated that studies of Recovery of Insulin Secretion, or RISE, have yielded enough blood samples for more advanced comparisons, as research funding is increased .
A hypothesis has yet to be studied, he said. The pancreatic cells that make the hormones responsible for glucose control are made in a mini organ called the islet, which includes beta cells that produce insulin and alpha cells that make glucagon. Insulin will lower glucose and glucagon will increase glucose.
"In an individual with diabetes, when the glucose level is too low, he secretes glucagon in an attempt to raise glucose again," Kahn said. "One possibility is that this relationship that is normally very tight and regulated between the amount of insulin and secreted glucagon – which we know a lot in adults – can be disrupted.
"Maybe children secrete more insulin and secrete more glucagon than adults, which pushes them through the physiological mechanism to get them to progress more quickly. If this concept were true, we could target the alpha cell in these children in a different way. "
The results of the study on pediatric drugs have recently been published in Diabetes Care along with two other manuscripts comparing young people with adults participating in trials as part of the RISE study.
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