COMMENTARY

Type 2 Diabetes in Teens: Severe Complications

Lorraine E. Levitt Katz, MD

Disclosures

August 06, 2019

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This transcript has been edited for clarity.

Hello. I'm Dr Lorraine Levitt Katz. I am professor of pediatrics at the Children's Hospital of Philadelphia (CHOP) and the University of Pennsylvania School of Medicine. I'm going to talk today about some of the research we've been doing here on pediatric type 2 diabetes.

We have been fortunate to be a member of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study group and I am the principal investigator for the TODAY study at CHOP. The TODAY study includes 15 sites nationwide and has been operating since 2001. The initial clinical trial of medication and treatment of recent-onset type 2 diabetes completed in 2011. Since that time, we have been studying long-term complications in the TODAY follow-up study. Recently, at the American Diabetes Association meeting, we presented some of the long-term results.

In the original trial,[1] we saw two different flavors of type 2 diabetes in youth. About half of patients did not maintain diabetes control on oral medication and moved on to insulin therapy. Another subset seemed to have improved glycemic control after the pubertal period.

However, our recent data from the TODAY follow-up study indicate that long-term complications in this group are actually worse than in adults in terms of the rapid rate of progression. Remember, these are youth now in their mid- to late 20s. We found high rates of complications of diabetes, including 55% of patients with hypertension, 40% with microalbuminuria, and 26%-30% with hyperlipidemia. Some patients have rapidly progressing eye disease. We are seeing elevated rates of neuropathy. We're also seeing some structural changes in the heart, with increased left ventricular mass and increased left atrial diameter. Some of these issues may have long-term complications related to cardiovascular risk.

A certain number of the women in TODAY have had their own children, and we are seeing a relatively high rate of pregnancy-related complications as well as complications in the offspring.

All of this has public health implications because complications of type 2 diabetes in youth are more severe than what we're seeing in the adult population and occur more rapidly.

We've encountered some obstacles in that there have been a limited number of drugs approved for this condition. So far, it has just been metformin and insulin. Liraglutide (Victoza) was just approved for use in children as young as 10 years of age. Pediatric diabetes providers will now be able to utilize this medication, but more medications are needed to treat young people with this condition.

The TODAY study group has a large biobank and DNA available for researchers who are interested in studying additional complications of type 2 diabetes.

We will have more publications coming out in the next year.

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