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Thursday 27th October 2016

Teens unlikely to manage diabetes well

30th April 2012

Teenagers with type 2 diabetes find it much harder than adults to keep their blood sugar levels under control, a new study has found.


The findings are a grim warning to overweight or obese teenagers not to develop the disease in the first place.

Researchers from the University of Colorado in Denver ran a series of tests among groups of teenagers with type 2 diabetes to determine which methods were most effective for this age group, which is now seeing rapidly growing rates of diabesity, diabetes brought on by obesity.

The study, the largest so far to examine the treatment and management of diabetes in teenagers, received funding from the federal government.

It found that type 2 diabetes in teenagers has a poor outlook because people in that age group are less likely to be able to comply with management guidelines, and one in five will suffer serious complications within a few years of diagnosis.

Nearly half of the newly diagnosed teenagers in the study had failed to keep to their management plan with a few years of the study's start date.

Previous studies of diabetes management have mostly focused on the adult population. Many diabetes drugs do not even have approval for use in minors.

According to study lead author Phil Zeitler, the message to teenagers was best summarised as a warning not to get diabetes at all.

Currently, around 30% of children and teenagers in the United States are overweight or obese, which puts them at a high risk of developing diabetes, a chronic disease in which the body is unable to use or make insulin to process sugar from food.

Before the obesity epidemic, children were rarely diagnosed with type 2 diabetes, with type 1 diabetes more common among juveniles.

The treatment of type 2 diabetes usually begins with metformin, which targets blood sugar, but further medication or direct injections of insulin may also be needed.

High levels of blood sugar carry the risk of loss of vision, nerve damage, limb amputation and kidney failure, not to mention heart attacks and strokes.

Among the 699 overweight and obese teens recently diagnosed with diabetes, all had their blood sugar normalized with metformin. Then, one group was given metformin alone, a second group received metformin with a second drug, Avandia, and the third received metformin, dietary modifications and exercise counselling.

Half of those in the group receiving metformin alone had failed to maintain control of their blood sugar levels, four years after the study began. The group that received two medications and the lifestyle modification programme fared slightly better, but not much.

One in five of all the study participants had serious complications which often resulted in hospitalisation, according to the study, which was funded by the National Institutes of Health and published in the New England Journal of Medicine. The drugs were donated by their manufacturers.

However, Avandia has been linked to an increased risk of heart attacks in adults, a finding which only became known after the study had started. Therefore, researchers concluded that they could not recommend the combination therapy.

Co-lead author Mitchell Geffner, of the Children's Hospital Los Angeles, said that teenagers were going to need more than metformin to manage their diabetes, and that a single approach would not deliver the desired result.

According to an editorial in the same journal by David Allen of the University of Wisconsin School of Medicine and Public Health, the study was yet another reason to change American attitudes to eating and activity.

Study participant Judith Garcia, 19, said she still struggles to manage her diabetes with metformin and insulin years, and to remember to watch her diet and set aside time to exercise.

And Cincinnati 14-year-old Kelsi Amer, who was diagnosed at age 12 and injects insulin morning and night, has to miss class at times to check her blood sugar or attend hospital for check-ups.

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