The future of pediatric type 2 diabetes

In her discussion, "The future of pediatric type 2 diabetes" at the virtual Scientific Sessions for the American Diabetes Association, Dr. Sonia Caprio, MD, from Yale University School of Medicine, discussed the close link between the prevalence of child obesity and type 2 diabetes (T2D); and lessons learned, in particular, from the Restoring Insulin Secretion (RISE) consortium (which tests interventions to slow or reverse the progression of beta-cell failure in those at high risk of T2D), the SEARCH study (a national multicenter study geared towards understanding more about diabetes among children and young adults), and the TODAY study (aimed at testing treatment options for T2D in adolescents).

In the RISE study, Dr. Caprio notes that "we have learned the profound degree of insulin resistance seen in obese youth with impaired glucose intolerance (IGT), or early T2D is unresponsive to the effects of metformin, or glargine and metformin. Additionally, beta-cell function continued to deteriorate with these 2 treatments. In this study, it was discovered that early treatment with IGT or T2D may require other medications, or for longer periods, to combat the severe insulin resistance." Furthermore, the study calls for further investigation to better understand the physiology underlying beta-cell dysfunction in youth, and better approaches to prevent and treat obesity, Dr. Caprio urged, "are critically needed."

In discussing trends in childhood obesity (children and adolescents aged 2 to 19 years), Dr. Caprio notes a "relentless rise:" between 1971 and 1974, 5% of youth were obese; in 2017, that number escalated to roughly 17% and continues on an upward trajectory." Obesity during puberty appears to be a particularly important factor involved in the increasing rise of type 2 diabetes in middle and late adulthood," Dr. Caprio pointed out. This, combined with the dramatic rise in T2D in native American Indians and African-Americans highlights the problem of the disease affecting more minority children. She also suggested that these youth trials may need to be designed differently to focus on small sample sizes with short (6 to 12 months) mechanism outcomes.

"This means," Dr. Caprio said, "challenging goals include the development of cost-effective, population-wide screening to identify at-risk individuals, improved biomarkers, and clinical testing of therapeutic agents which offer a better opportunity to modify disease progression because of higher endogenous beta-cell reserves."

"The future is ahead of us, and will not be easy, but we need to find better remedies to prevent complications that we are seeing right now," she concluded.

Reference

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