%0 Journal Article
%T Management of Pediatric and Adolescent Type 2 Diabetes
%A M. Constantine Samaan
%J International Journal of Pediatrics
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/972034
%X Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents. 1. Introduction Type 2 diabetes (T2D) is increasing in youth, driven by the obesity epidemic that is affecting millions of children around the world [1]. T2D is a serious disorder with multiple complications that appear early in the course of the disease. Since T2D in young people has been only recognized over the past few years, knowledge of its natural history is lacking, and there are only few studies examining treatments beyond metformin and insulin. Even in case of the latter two medications, randomized controlled trials are very few, and knowledge is still accumulating in this field. One study whose results were published about the role of different treatment modalities in T2D is the treatment options for type 2 diabetes in youth (TODAY) study [2]. This was a large, longitudinal, randomized, multicenter study that recruited 699 children and adolescents with an age range of 10¨C17 years and female to male ratio of 2£¿:£¿1. These patients were randomized to three treatment groups that included metformin alone or in combination with lifestyle intervention (LSI) or rosiglitazone. The mean time since diagnosis of T2D was 7.8 months and HbA1c less than 8% on enrollment. The primary outcomes, defined as failure to maintain HbA1c less than 8% over 6 months or metabolic decompensation requiring insulin therapy at diagnosis or restarting after stopping insulin within 3 months, occurred in 51.7%, 46.6%, and 38.6% in the above groups, respectively [2]. Metformin alone was no different from metformin plus LSI in improving metabolic outcomes, and higher failure rates in black participants were noted. Combination therapy of metformin plus rosiglitazone offered better success rates especially in girls but was associated with more weight gain. Despite intensive LSI, the rates of clinically important weight loss (7% or more) were achieved in only 24.3% in the metformin group, 31.2% in the metformin plus LSI groups, and in only 16.7% in the metformin
%U http://www.hindawi.com/journals/ijpedi/2013/972034/