Children with Type-2 diabetes a challenge to treat

SAN ANTONIO (May 4, 2012) — In a study involving UT Medicine pediatricians published in the New England Journal of Medicine this week, a comparison of different drug and lifestyle interventions for children with Type 2 diabetes showed that therapy with metformin alone failed for more than half of the young participants.

And the worrisome outcome of the patients in all the study groups highlights the vital importance of preventing Type 2 diabetes in children in the first place.

“Most of these children have parents with diabetes, but it’s not acting like the same disease in their young bodies,” said Jane Lynch, M.D., associate professor of pediatric endocrinology in the School of Medicine at The University of Texas Health Science Center at San Antonio. “The children are getting it earlier, it’s harder to control, and it’s leading much more rapidly to serious complications like kidney and cardiovascular disease.”

A team of researchers led by Dr. Lynch and Daniel Hale, M.D., professor of pediatric endocrinology at the Health Science Center, ran the San Antonio site of the TODAY. Forty-five San Antonio children participated in the 699-subject, 16-site national study.

The children on the combined therapy did the best, followed by the children on one drug, metformin, who had aggressive diet and exercise counseling. The children on metformin alone did the least well, even though they, too, received education and clinical management with an experienced team.

But even with the two-drug treatment, almost 39 percent of those children lost the ability to produce insulin on their own and had to switch to insulin shots. The failure rate for the metformin and lifestyle group was 46.6 percent, and it was more than half, 52 percent, for the ones on metformin alone.

Metformin is commonly prescribed to help control Type-2 diabetes in adults. In this study of children it had a much higher failure rate than in studies of adults. The second drug used in the combination group was rosiglitazone. Rosiglitazone’s use has been restricted since the study began because of a higher risk of stroke in adults, but the study’s investigators said there are new, similarly-acting drugs that appear to be safer and could be used for the combination therapy.

“As the problem of childhood obesity continues to worsen, we are seeing more and more children and adolescents with Type 2 diabetes,” Dr. Hale said. “While we have learned much about Type 2 diabetes treatment in children and adolescents, the best thing is to prevent Type 2 diabetes. For that, it’s back to the basics: more activities and time with friends and family, less TV and video, and fewer sugary drinks.”

The opportunities for better activity and health abound in San Antonio, Dr. Hale added, and there are more of them all the time.

“We have great weather for much of the year, and we have a good-tasting and safe public water supply,” he said. “Our city leadership is working on making it more and more possible to be active – adding bike programs, bike lanes, sidewalks, enhancing parks, etc. So let’s use them.”

The study, begun in 2004 and operated at the Texas Diabetes Clinic, a University Health System facility, was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

UT Medicine San Antonio is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at for a complete listing of clinics and phone numbers.

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