<http://www.diabetesincontrol.com>

Type 2 More Dangerous in Children
Alarming increases of type 2 diabetes in children are no closer to being
managed successfully and more aggressive treatment is needed at the start of
diagnosis due to the fact that one drug is not enough to control blood
sugars....

The study showed that common diabetes-control medications failed to work in
children and found that because children develop type 2 diabetes at younger
ages, there is an increased lifetime risk for serious complications such as
heart attack and stroke. Dr. Terri H. Lipman, co-investigator from the
Miriam Stirl Endowed Term Professor of Nutrition and professor of nursing of
children, is an expert in pediatric diabetes. Dr. Lipman stated that,
"Increases in childhood obesity have yielded an increased incidence of type
2 diabetes in children." "It is important to understand that the epidemic of
type 2 diabetes in youth is secondary to high caloric intake and low
activity. Both of these causes are a result of a multitude of socioeconomic
factors that include food deserts and lack of safe places for activity."

Researchers analyzed 699 overweight children, ages 10 to 17, who were
recently diagnosed with Type 2 diabetes, and found that 46 percent of those
treated with the drug metformin, commonly used for diabetes control in
adults, were not able to maintain healthy blood sugar levels. They needed to
begin more powerful insulin injections within slightly less than a year.
Among all the study participants, one in five had a serious complication
such as very high blood sugar, typically leading to hospitalization. The
study also suggested that a healthy lifestyle has little bearing on the
effectiveness of treatment.

The purpose of the current study was to identify the best treatment for
youth with type 2 diabetes. All participants were overweight, some very
obese. All received diabetes education, with the support of a parent or
guardian. They were then assigned at random to one of three groups. One
group took only metformin, a standard diabetes medication (also called
Glucophage). Another took metformin and a second medication, rosiglitazone
(also called Avandia). A third group took metformin and went through an
intensive diet, exercise, and weight-loss program, which has been successful
in adults. All participants were followed for an average of four years.

All three regimens yielded high failure rates and were unable to control
blood sugar levels. Metformin alone failed in 52 percent of participants;
metformin plus rosiglitazone failed in 39 percent of participants; and
metformin plus the diet program failed in 47 percent of participants.
Metformin alone was least effective in African-American participants, and
metformin combined with rosiglitazone worked better in girls than in boys.
The failure rates were high even in the participants who adhered most
strictly to their treatment programs.

"There is disappointment that the lifestyle intervention was not more
effective, particularly because this intensive intervention included both a
personal activity-nutrition leader (a study member acting as a lifestyle
coach) and a family member designated for support throughout the
intervention," said Dr. Lipman. "What we have learned is that the effect of
the obesity-prone environment of these youths is even more difficult to
overcome than we had predicted."

The article :

<http://www.nejm.org/doi/pdf/10.1056/NEJMoa1109333>

A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes
The New England Journal Of Medicine
TODAY Study Group
April 29, 2012 (10.1056/NEJMoa1109333)

Gys