The future of pediatric type 2 diabetes

In her discussion, “The Future of Type 2 Diabetes in Children” during the virtual science sessions for the American Diabetes Association, Dr. Sonia Caprio, MD, of Yale University School of Medicine, the close link between the prevalence of childhood obesity and type 2 diabetes (T2D); and lessons learned in particular from the Restoring Insulin Secretion (RISE) consortium (which is testing interventions to slow or reverse the progression of beta-cell failure in people at high risk for T2D), the SEARCH study (a national multicenter study focusing on understanding diabetes in children and young adults), and the TODAY study (aimed at testing treatment options for T2D in adolescents).

In the RISE study, Dr. Caprio noted that “we discovered the profound degree of insulin resistance seen in obese youth with impaired glucose intolerance (IGT), or early T2D unresponsive to the effects of metformin, or glargine and metformin. In addition, beta cell function continued to deteriorate with “These 2 treatments. This study found that early treatment with IGT or T2D may require different drugs, or for longer periods of time, to combat the severe insulin resistance.” In addition, the study calls for further research to better understand the physiology underlying beta-cell dysfunction in young people, and better approaches to prevent and treat obesity, Dr. Caprio to, “are critical.”

In discussing trends in childhood obesity (children and adolescents ages 2 to 19), Dr. Caprio recorded a “relentless rise”: Between 1971 and 1974, 5% of young people were obese; in 2017, that number escalated to about 17% and continues to follow an upward trajectory. “Obesity during puberty appears to be a particularly important factor in the increasing increase in type 2 diabetes in mid- and late adulthood,” emphasized Dr. Capri. This, coupled with the dramatic increase in T2D among Native American Indians and African Americans, highlights the problem of the disease affecting more minority children. She also suggested that these youth studies may need to be redesigned to focus on small sample sizes with short (6 to 12 months) mechanism outcomes.

“This means,” said Dr. Caprio, “challenging targets include the development of cost-effective, population-wide screening to identify at-risk individuals, improved biomarkers, and clinical testing of therapeutic agents that offer a better ability to modify disease progression due to higher endogenous beta-cell reserves.”

“The future is ahead of us and it won’t be easy, but we need to find better remedies to avoid the complications we see now,” she concluded.

Reference

Caprio S. The future of type 2 diabetes in children. American Diabetes Association Scientific Sessions 2021; June 27, 2021; virtual. Accessed June 27, 2021.

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