"Diabesity", the combination of obesity and type 2 diabetes, seems to progress much faster in adolescents than in adults and, in addition, to further complicate the situation, it is more resistant to standard treatment.A rigorous study published in The New England Journal of Medicine warns that most cases, almost half of the 699 adolescents analyzed, did not respond to conventional treatment.
Bad controlled diabetes involves important problems in the future as it significantly increases the risk of heart disease, viewing problems, amputations and renal insufficiency.The longer the disease is prolonged, the greater the risk.So, in theory, people who develop diabetes such as children can suffer complications much sooner than previous generations that became diabetics when they were adults.In Spain it is estimated that there are about 29,000 (between boys and girls) under 15 who have diabetes.
The epidemic of childhood obesity has given rise to the appearance of type 2 diabetes in young people.However, because type 2 diabetes has been mainly an adult disease, there is very little information about how to effectively treat adolescents, and pediatricians have had to trust what is known about the treatment of adults.
In fact, the causes for which the disease is so difficult to control in children and adolescents are unknown.It is speculated that rapid growth and intense hormonal changes in puberty can play a role.
The research, conducted by the Treatment Options for Type 2 Diabetes in Adolescents and Youth Study Group (Today) is the first great study on type 2 diabetes in children.The work controlled 699 children from 10 to 17 years for four years.The results showed that oral standard treatment used for type 2 diabetes had ceased to be effective in approximately half of the patients, and that in many of them the use of insulin had been necessary, with daily injections, to control theBlood sugar levels.In fact, researchers were surprised by the lack of efficacy of oral drugs in adolescents.
The best treatment
The study, funded by the National Health Institutes (NIH), and published in NEJM has compared the efficacy of two diabetes, metformin and rosiglitazone medications, with the use of metformin monotherapy.The objective of the work, experts say, was to identify the best treatment for these patients.Thus, they randomly assigned the following treatments: Metformin;Metformin and rosiglitazone, or metformin and an intensive diet, exercise and weight loss program.
The results were disappointing: the three regimes had high failure rates, which means that they could not control blood sugar.Metformin therapy alone was not an effective treatment for many of these young people.In fact, metformin had a much greater failure rate than is observed in adults.
For experts, the conclusion is obvious: more and better treatments are needed.In addition, rosiglitazone is not a good option, because its use has been related to a higher risk of heart attack and stroke in adults, and its use has been restricted in Europe and the USDiabetes, but none has been accepted or tested in children.
more aggressive
"The results of this study show that it would be good to start with a more aggressive treatment in young people with type 2 diabetes," explains Philip Zeitler.«We are learning that type 2 diabetes is a more aggressive disease in young people than in adults and thatProgress more quickly, what could be the reason why metformin in monotherapy presents a much greater failure rate than expected ».
The study also demonstrates that a program that includes a change in lifestyle, effective in adults, does not achieve glycemia control in adolescents."Despite a rigorous intervention in the lifestyle, we have not been able to achieve sustained changes over time in your lifestyle," explains Barbara Linder.
For Griffin P. Rodgers, «the study provides very necessary information on how to treat type 2 diabetes in young people.The first studies in adults have shown that early and effective treatment can prevent serious complications of diabetes.In the long term, it would be important to know if a more aggressive therapy for young people with type 2 diabetes is beneficial.
Published in: ABC Health ( Link ... 11889.html )
