Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Diabetes Reports
Published in: Current Diabetes Reports 1/2013

01-02-2013 | Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)

Current Treatment Options for Type 2 Diabetes Mellitus in Youth: Today’s Realities and Lessons from the TODAY Study

Authors: Minu M. George, Kenneth C. Copeland

Published in: Current Diabetes Reports | Issue 1/2013

Login to get access

Abstract

The incidence of type 2 diabetes in children and adolescents has increased over the last 2 decades, paralleled by an increase in obesity over the same time period. Although the value of lifestyle modification in obese youth is unquestioned, scant evidence for optimal treatment of type 2 diabetes in this age group exists. Despite recent therapeutic drug trials, metformin and insulin are the only medicines currently approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes in youth. Because of recently amended pharmaceutical regulations, however, it is likely that more antidiabetic medications soon will be added to the armamentarium of therapeutic options for youth with type 2 diabetes. Additionally, the recently published TODAY study comparing safety and efficacy of three treatment regimens in maintaining glycemic control in youth with type 2 diabetes has shed new light on the problem.
Literature
1.
Kaufman FR. Type 2 diabetes mellitus in children and youth: a new epidemic. J Pediatr Endocrinol Metab. 2002;15 Suppl 2:737–44.PubMed
2.
Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700.PubMedCrossRef
3.
Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136(5):664–72.PubMedCrossRef
4.
Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000;23(3):381-9.
5.
Copeland KC, Chalmers LJ, Brown RD. Type 2 diabetes in children: oxymoron or medical metamorphosis? Pediatr Ann. 2005;34(9):686–97.PubMed
6.
Weiss R, Caprio S, Trombetta M, Taksali SE, Tamborlane WV, Bonadonna R. Beta-cell function across the spectrum of glucose tolerance in obese youth. Diabetes. 2005;54(6):1735–43.PubMedCrossRef
7.
Giannini C, Weiss R, Cali A, Bonadonna R, Santoro N, Pierpont B, et al. Evidence for early defects in insulin sensitivity and secretion before the onset of glucose dysregulation in obese youths: a longitudinal study. Diabetes. 2012;61(3):606–14.PubMedCrossRef
8.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.PubMedCrossRef
9.
Liese AD, D'Agostino Jr RB, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;118(4):1510–8.PubMedCrossRef
10.
Dabelea D, Bell RA, D'Agostino Jr RB, Imperatore G, Johansen JM, Linder B, et al. Incidence of diabetes in youth in the United States. JAMA. 2007;297(24):2716–24.PubMedCrossRef
11.
12.
Amed S, Dean HJ, Panagiotopoulos C, Sellers EA, Hadjiyannakis S, Laubscher TA, et al. Type 2 diabetes, medication-induced diabetes, and monogenic diabetes in Canadian children: a prospective national surveillance study. Diabetes Care. 2010;33(4):786–91.PubMedCrossRef
13.
• Copeland KC, Zeitler P, Geffner M, Guandalini C, Higgins J, Hirst K, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab. 2011;96(1):159–67. Description of baseline characteristics of the patients in the TODAY study.PubMedCrossRef
14.
Copeland K, Pankratz K, Cathey V, Immohotichey P, Maddox J, Felton B, et al. Acanthosis Nigricans, insulin resistance (HOMA) and dyslipidemia among Native American children. J Okla State Med Assoc. 2006;99(1):19–24.PubMed
15.
Dabelea D, Mayer-Davis EJ, Lamichhane AP, D'Agostino Jr RB, Liese AD, Vehik KS, et al. Association of intrauterine exposure to maternal diabetes and obesity with type 2 diabetes in youth: the SEARCH Case-Control Study. Diabetes Care. 2008;31(7):1422–6.PubMedCrossRef
16.
Dabelea D, Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab. 2001;14(8):1085–91.PubMed
17.
Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr. 1987;110(3):481–7.PubMedCrossRef
18.
Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001;50(11):2444–50.PubMedCrossRef
19.
Moran A, Jacobs Jr DR, Steinberger J, Hong CP, Prineas R, Luepker R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999;48(10):2039–44.PubMedCrossRef
20.
Saad RJ, Danadian K, Lewy V, Arslanian SA. Insulin resistance of puberty in African-American children: lack of a compensatory increase in insulin secretion. Pediatr Diabetes. 2002;3(1):4–9.PubMedCrossRef
21.
Bacha F, Lee S, Gungor N, Arslanian SA. From pre-diabetes to type 2 diabetes in obese youth: pathophysiological characteristics along the spectrum of glucose dysregulation. Diabetes Care. 2010;33(10):2225–31.PubMedCrossRef
22.
Bacha F, Gungor N, Lee S, Arslanian SA. In vivo insulin sensitivity and secretion in obese youth: what are the differences between normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes? Diabetes Care. 2009;32(1):100–5.PubMedCrossRef
23.
Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004;114(1):217–23.PubMedCrossRef
24.
•• Standards of medical care in diabetes--2012. Diabetes Care. 2012;35 Suppl 1:S11-63. Provides standards of care as recommended by the ADA and is updated yearly.
25.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.PubMedCrossRef
26.
Willi SM, Martin K, Datko FM, Brant BP. Treatment of type 2 diabetes in childhood using a very-low-calorie diet. Diabetes Care. 2004;27(2):348–53.PubMedCrossRef
27.
Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation. 2012;125(9):1157–70.PubMedCrossRef
28.
Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–6.PubMedCrossRef
29.
Giannini C, de Giorgis T, Mohn A, Chiarelli F. Role of physical exercise in children and adolescents with diabetes mellitus. J Pediatr Endocrinol Metab. 2007;20(2):173–84.PubMedCrossRef
30.
Pinhas-Hamiel O, Standiford D, Hamiel D, Dolan LM, Cohen R, Zeitler PS. The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus. Arch Pediatr Adolesc Med. 1999;153(10):1063–7.PubMed
31.
Swift PG. ISPAD clinical practice consensus guidelines 2006-2007. Diabetes education. Pediatr Diabetes. 2007;8(2):103–9.PubMedCrossRef
32.
•• Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, Arslanian S, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56 Reports the primary outcome results of the TODAY study.PubMedCrossRef
33.
Pinhas-Hamiel O, Zeitler P. Clinical presentation and treatment of type 2 diabetes in children. Pediatr Diabetes. 2007;8 Suppl 9:16–27.PubMedCrossRef
34.
Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. ISPAD clinical practice consensus guidelines 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes. 2008;9(5):512–26.PubMedCrossRef
35.
Jones KL, Arslanian S, Peterokova VA, Park JS, Tomlinson MJ. Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial. Diabetes Care. 2002;25(1):89–94.PubMedCrossRef
36.
Bristol-MyersSquibbCompany. Label Information; Glucophage & Glucophage XR. Bristol-Myers Squibb Company. August 27, 2008. Accessed July 24th 2012.
37.
Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metab. 2008;21(4):339–48.PubMedCrossRef
38.
Grossman SL, Lessem J. Mechanisms and clinical effects of thiazolidinediones. Expert Opin Investig Drugs. 1997;6(8):1025–40.PubMedCrossRef
39.
40.
41.
42.
•• Vaidyanathan J, Choe S, Sahajwalla CG. Type 2 diabetes in pediatrics and adults: thoughts from a clinical pharmacology perspective. J Pharm Sci. 2012;101(5):1659–71. Provides a concise overview of pharmacologic studies done in pediatrics, as compared with adults.PubMedCrossRef
43.
Vajo Z, Fawcett J, Duckworth WC. Recombinant DNA technology in the treatment of diabetes: insulin analogs. Endocr Rev. 2001;22(5):706–17.PubMedCrossRef
44.
Swan KL, Weinzimer SA, Dziura JD, Steil GM, Voskanyan GR, Steffen AT, et al. Effect of puberty on the pharmacodynamic and pharmacokinetic properties of insulin pump therapy in youth with type 1 diabetes. Diabetes Care. 2008;31(1):44–6.PubMedCrossRef
45.
Bangstad HJ, Danne T, Deeb L, Jarosz-Chobot P, Urakami T, Hanas R. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2009;10 Suppl 12:82–99.PubMedCrossRef
46.
Lepore M, Pampanelli S, Fanelli C, Porcellati F, Bartocci L, Di Vincenzo A, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49(12):2142–8.PubMedCrossRef
47.
Danne T, Datz N, Endahl L, Haahr H, Nestoris C, Westergaard L, et al. Insulin detemir is characterized by a more reproducible pharmacokinetic profile than insulin glargine in children and adolescents with type 1 diabetes: results from a randomized, double-blind, controlled trial. Pediatr Diabetes. 2008;9(6):554–60.PubMedCrossRef
48.
• Rao RS, Kini S. Diabetic and bariatric surgery: a review of the recent trends. Surg Endosc. 2012;26(4):893–903. Latest review of results of the available data on bariatric surgery to date.PubMedCrossRef
49.
Inge TH, Miyano G, Bean J, Helmrath M, Courcoulas A, Harmon CM, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents. Pediatrics. 2009;123(1):214–22.PubMedCrossRef
50.
Brandt ML, Harmon CM, Helmrath MA, Inge TH, McKay SV, Michalsky MP. Morbid obesity in pediatric diabetes mellitus: surgical options and outcomes. Nat Rev Endocrinol. 2010;6(11):637–45.PubMedCrossRef
51.
Michalsky M, Kramer RE, Fullmer MA, Polfuss M, Porter R, Ward-Begnoche W, et al. Developing criteria for pediatric/adolescent bariatric surgery programs. Pediatrics. 2011;128 Suppl 2:S65–70.PubMedCrossRef
52.
Al-Qahtani AR. Laparoscopic adjustable gastric banding in adolescent: safety and efficacy. J Pediatr Surg. 2007;42(5):894–7.PubMedCrossRef
53.
Zeitler P, Epstein L, Grey M, Hirst K, Kaufman F, Tamborlane W, et al. Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes. 2007;8(2):74–87.PubMedCrossRef
54.
Copeland KC, el Ghormli L. Body composition during the TODAY randomized clinical trial. ADA abstract # 230-OR; 2012; Philadelphia, PA.
55.
White N. Treatment and clinical course of recent-onset type 2 diabetes in youth–data from the TODAY trial. ADA symposium; 2012; Philadelphia, PA.
56.
Copeland K. Treatment and clinical course of recent-onset type 2 diabetes in youth – data from the TODAY trial. ADA symposium; 2012; Philadelphia, PA.
Metadata
Title
Current Treatment Options for Type 2 Diabetes Mellitus in Youth: Today’s Realities and Lessons from the TODAY Study
Authors
Minu M. George
Kenneth C. Copeland
Publication date
01-02-2013
Publisher
Current Science Inc.
Published in
Current Diabetes Reports / Issue 1/2013
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-012-0334-z

Other articles of this Issue 1/2013

Current Diabetes Reports 1/2013 Go to the issue

Diabetes and Pregnancy (CJ Homko, Section Editor)

Fetal Macrosomia and Shoulder Dystocia in Women with Gestational Diabetes: Risks Amenable to Treatment?

Hospital Management of Diabetes (G Umpierrez, Section Editor)

Management of Post-Transplant Diabetes

Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)

Are the ADA Hemoglobin A1c Criteria Relevant for the Diagnosis of Type 2 Diabetes in Youth?

Hospital Management of Diabetes (G Umpierrez, Section Editor)

Management of Hyperglycemia in Hospitalized Patients with Renal Insufficiency or Steroid-Induced Diabetes

Hospital Management of Diabetes (G Umpierrez, Section Editor)

Management of Hyperglycemia During Enteral and Parenteral Nutrition Therapy

Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)

Etiology of Insulin Resistance in Youth with Type 2 Diabetes
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits