Treatment of type 2 diabetes mellitus in children and adolescents
Abstract
OBJECTIVES: To study possible treatment modalities for type 2 diabetes mellitus (T2DM) in children and adolescents.
STUDY DESIGN: We reviewed the medical records of the 25 children and adolescents most recently seen for T2DM in the U.T. Houston diabetes clinics, comparing treatment regimens and results over time. The most common treatment modalities were insulin in combination with oral insulin sensitizing agent (metformin), and metformin alone. End-points evaluated included HbA1c, body weight, and insulin dose.
PATIENTS: Patients ranged in age from 8 to 15 years at diagnosis. The female:male ratio was 1.3:1. Sixty percent of patients were Hispanic. All BMIs were above 85th percentile for age and sex. Acanthosis nigricans was present in 92% of the patients.
RESULTS: Insulin was the only initial treatment in 18 patients (72%), with metformin added and insulin withdrawn as euglycemia developed. Only five of these 18 patients who were started on insulin were completely weaned to metformin monotherapy, and three of those patients later required reintroduction of insulin due to poor control. Metformin did permit reduction of insulin dose in the combination group. Metformin was used as monotherapy in seven patients (28%), but three of them later required another oral hypoglycemic agent. The mean change in HbA1c over the observed period was -2.9% in patients taking insulin only, -2.3% for patients treated with insulin + metformin, and -4.4% in patients who could be treated by…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 25 participants or records.
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