Type 2 diabetes tough to treat in overweight teens, study shows
(CBS/AP) Overweight teens face an uphill battle when diagnosed with type 2 diabetes, new research suggests.
As few as 15 years ago, a teen with type 2 diabetes was a rare occurrence. Now, one-third of American children and teens are overweight or obese and they face a higher risk of developing the disease in which the body can't make enough insulin or use what it does make to process sugar from food. The more common kind of diabetes in children is Type 1, which used to be called juvenile diabetes.
A major study published in the April 29 issue of the New England Journal of Medicine tested several ways to manage blood sugar in overweight and obese teens newly diagnosed with diabetes and found that nearly half of them failed within a few years and one in five suffered serious complications. The results spell trouble for a nation facing rising rates of "diabesity" - Type 2 diabetes brought on by obesity.
The NIH-funded study is the largest look yet at how to treat diabetes in teens. Earlier studies mostly have looked at adults, and most diabetes drugs aren't even approved for youths. Doctors typically start treating type 2 diabetes with metformin, a pill to lower blood sugar. If it still can't be controlled, other drugs and daily insulin shots may be needed. The longer blood sugar runs rampant, the greater the risk of suffering vision loss, nerve damage, kidney failure, limb amputation, heart attacks and strokes.
Judith Garcia still struggles to manage her diabetes with metformin and insulin years after taking part in the study at Children's Hospital Los Angeles. She has to remember to watch her diet and set aside time to exercise.
"Trust me, I'm working on it," said the 19-year-old who lives in Commerce, Calif.
The new study sought to find out: What's the best way for teens to keep diabetes in check?
Researchers looked at 699 overweight and obese teens recently diagnosed with diabetes. All had their blood sugar normalized with metformin, then were given one of three treatments to try to maintain that control: metformin alone, metformin plus diet and exercise counseling, or metformin plus a second drug, Avandia. Drug companies donated the medications.
After almost four years, half the teens in the metformin group failed to maintain blood sugar control. The odds were a little better for the group that took two drugs but not much different for those in the lifestyle group.
"Two drugs right off the bat, that's an important finding," Dr. Robin Goland, professor of clinical medicine and pediatrics at Columbia University in New York City, told the CBS Evening News. "Taking medicines chronically, especially two drugs, would be very difficult for a teenager."
Study author Dr. Phil Zeitler, head of endocrinology of the University of Colorado Denver's Children's Hospital said doctors would not recommend this combination drug therapy because Avandia has since been linked to higher risk of heart attacks in adults - risks that became known after this study had started.
Another study leader from Children's Hospital Los Angeles, Dr. Mitchell Geffner, agreed that Avandia can't be recommended for teens, but said the study makes clear they will need more than metformin to control their disease.
"A single pill or single approach is not going to get the job done," he said.
Among all the teens in the study, 1 in 5 had a serious complication such as very high blood sugar, usually landing them in the hospital. The message from the study is clear: Prevention is key.
"Don't get diabetes in the first place," said Zeitler
The "discouraging" results point to the need to create "a healthier 'eat less, move more'" culture to help avoid obesity that contributes to diabetes, Dr. David Allen, a professor of pediatric diabetes and endocrinology at the University of Wisconsin School of Medicine and Public Health, wrote in an accompanying editorial.
Diabetes expert Dr. Mark Hyman, author of "The Blood Sugar Solution," shared a similar sentiment with CBS This Morning.
"The takeaway is that we're needing a national wakeup call," Hyman said. "We're not going to solve this in the doctor's office, we have to solve this in the communities where people live." He suggests soda taxes and laws aimed at changing food marketing to kids to help curb the rates.
"You can't medicate your way out of a bad diet."
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