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Children's Hospital Colorado -​​

Study Points to More Individualized Treatment for Diabetes



New results from the Treatment Options for Type 2 Diabetes in Youth study (TODAY) examined predictors of the outcomes in youth with onset type 2 diabetes (T2D) based on early characteristics at diagnosis, and suggests the need for specific criteria for adolescents that are different from those in adults. The findings indicate that if youth with T2D have an A1C greater than 6.3 percent three months after beginning treatment with metformin, the drug generally accepted as the first drug to be used in the treatment of T2D, they have nearly four times the risk for losing glucose control, within a median time of 11 months.

The TODAY study, the largest clinical trial to study the treatment of youth-onset T2D to-date, randomly assigned youth with T2D to one of three treatment groups to examine optimal approaches for disease management: metformin alone, metformin and rosiglitazone together, or metformin plus an intensive lifestyle program aimed to help participants lose weight and increase exercise.

The primary results of the TODAY study have been previously reported and showed that approximately 50 percent of youth with T2D failed treatment with metformin, the first drug generally used in treatment of T2D. This failure rate is much higher than that seen with metformin therapy in adult patients, suggesting that progression of the disease may be more aggressive in some youth than adults.

At the same time, the study showed that 50 percent of participants were able to maintain glucose control regardless of treatment group. These results suggested that there may be at least two distinct populations of youth with T2D, where one group needs intensive therapy to maintain blood glucose levels and the other does not.

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