ESPE Yearbook of Paediatric Endocrinology

Pediatr Diabetes. 2018 May 15. doi: 10.1111/pedi.12691

There is a small but significant debate as to whether or not type 1 (T1D) and type 2 diabetes (T2D) are the same disease with albeit different course. It might therefore be prudent to include into a chapter on T1D a publication on T2D. This study aimed to describe recent medication patterns and changes in medication patterns and glycemic control in adolescents and young adults with incident T2D. Data from the SEARCH for Diabetes in Youth Study, were included in cross-sectional analyses of treatments for adolescents and young adults with incident T2D in two time periods: 2002–2005 and 2008/2012. In addition, a longitudinal analysis of medications and glycemic control for a subset of patients with baseline and follow-up visits was carried out.

In the cross-sectional analysis, of 646 patients classified as having incident T2D, a majority in each year period received metformin (64.9% vs 70.4%) and/or insulin (38.1% vs 38.4%), while few used sulfonylureas (5.6% vs 3.6%) with non-significant changes over time. There was a significant reduction in thiazolidinedione use over time (5.0% vs 2.0%, P<0.05). In the longitudinal analysis, 322 participants were followed for 7 years, on average. Baseline metformin users had a lower HbA1C (6.4% [46.7 mmol/mol]) compared to insulin users (8.4% [68.2 mmol/mol], P<0.001) or insulin plus any oral diabetes medication (ODM) (7.7% [60.4 mmol/mol], P<0.001). Among baseline metformin users (n=138), 29.7% reported using metformin at follow-up, with the remainder adding (19.6%) or switching to insulin (8.0%), ODM (15.9%), or lifestyle only (26.8%). Of those receiving insulin (±ODM) (n=129), 76% reported insulin use at follow-up. Overall, only 35% were at A1C goal (<7.0%, 53 mmol/mol) at follow-up.

Youth-onset T2D is still largely being treated with metformin and/or insulin. The majority did not achieve the American Diabetes Association (ADA)-recommended A1C goal 7 years after diagnosis. Most importantly, adolescents classified as having T2D but requiring insulin might have been misdiagnosed and later on might actually turn out to have T1D and obesity. It is important to note that classification of diabetes into T1D or T2D is difficult, might even be misleading and in some cases might very well prohibit early and appropriate use of insulin as first line treatment. It is disturbing that many of the adolescents upon follow-up did not meet treatment targets as recommended by ADA. This fact might be attributable in part to the large number from poor family backgrounds with low education and low incomes.