Zuhri-Yafi Mohammad I, Brosnan Patrick G, Hardin Dana S
Department of Pediatrics, The University of Texas Medical School-Houston, 77030, USA.
J Pediatr Endocrinol Metab. 2002 Apr;15 Suppl 1:541-6.
To study possible treatment modalities for type 2 diabetes mellitus (T2DM) in children and adolescents.
We reviewed the medical records of the 25 children and adolescents most recently seen for T2DM in the U.T. Houston diabetes clinics, comparing treatment regimens and results over time. The most common treatment modalities were insulin in combination with oral insulin sensitizing agent (metformin), and metformin alone. End-points evaluated included HbA1c, body weight, and insulin dose.
Patients ranged in age from 8 to 15 years at diagnosis. The female:male ratio was 1.3:1. Sixty percent of patients were Hispanic. All BMIs were above 85th percentile for age and sex. Acanthosis nigricans was present in 92% of the patients.
Insulin was the only initial treatment in 18 patients (72%), with metformin added and insulin withdrawn as euglycemia developed. Only five of these 18 patients who were started on insulin were completely weaned to metformin monotherapy, and three of those patients later required reintroduction of insulin due to poor control. Metformin did permit reduction of insulin dose in the combination group. Metformin was used as monotherapy in seven patients (28%), but three of them later required another oral hypoglycemic agent. The mean change in HbA1c over the observed period was -2.9% in patients taking insulin only, -2.3% for patients treated with insulin + metformin, and -4.4% in patients who could be treated by metformin alone. HbA1c tended to rise after 2 years of therapy. Few patients sustained weight loss, regardless of treatment regimen.
Metformin appears to be an effective medication for the treatment of T2DM in children, but did not seem to be a sufficient long-term monotherapy in our protocol, which required euglycemia for insulin withdrawal. Lifetime management strategies for children with T2DM will probably be as complex as those for adults.
