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. 2018 Sep;19(6):1065-1072.
doi: 10.1111/pedi.12691. Epub 2018 Jun 13.

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study

Cathy A Pinto  1 , Jeanette M Stafford  2 , Tongtong Wang  1 , R Ravi Shankar  3 , Jean M Lawrence  4 , Grace Kim  5 , Catherine Pihoker  5 , Ralph B D'Agostino Jr  2 , Dana Dabelea  6
Affiliations

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study

Cathy A Pinto et al. Pediatr Diabetes. 2018 Sep.

Abstract

Objective: The aim of this study was to describe recent medication patterns and changes in medication patterns and glycemic control in adolescents and young adults with incident type 2 diabetes (T2D).

Methods: Using data from the SEARCH for Diabetes in Youth Study, we conducted a cross-sectional analysis of treatments for adolescents and young adults with incident T2D in 2 periods (2002-2005 vs 2008/2012), and a longitudinal analysis of medications and glycemic control for a subset with baseline and follow-up visits. Comparisons were performed using χ2 , Fisher's exact, or ANOVA.

Results: Of 646 individuals in the cross-sectional analysis, a majority in each period received metformin (64.9% vs 70.4%) and/or insulin (38.1% vs 38.4%), while fewer used sulfonylureas (5.6% vs 3.6%) with non-significant changes over time. There was a significant reduction in thiazolidinedione use (5.0% vs 2.0%, P < .05). In the longitudinal analysis, 322 participants were followed for 7 years, on average. Baseline metformin users had a lower A1C (6.4% [46.7 mmol/mol]) compared to insulin (8.4% [68.2 mmol/mol], P < .001) or insulin plus any oral diabetes medication (ODM) users (7.7% [60.4 mmol/mol], P < .001). Among baseline metformin users (n = 138), 29.7% reported 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, 35% were at A1C goal (<7.0%, 53 mmol/mol) at follow-up.

Conclusions: Youth-onset T2D is still largely being treated with metformin and/or insulin. The majority treated were not at American Diabetes Association (ADA)-recommended goal 7 years after diagnosis.

Keywords: adolescent and young adult; diabetes mellitus; glycated hemoglobin A; type 2 diabetes.

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Conflict of interest statement

Conflict of Interest

CAP, TW, RRS are employees and stockholders of Merck & Co., Inc., Kenilworth, NJ USA, which currently sells and distributes a DPP-4 inhibitor.

Figures

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Figure 2
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