Small patients, big problems with diabetes

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A recent study published in The New England Journal of Medicine has spotlighted some complex problems regarding the treatment of type 2 diabetes in children. Because diabetic children respond differently than adults to conventional treatments, the study examined the efficacy of three different treatment approaches in adolescents. Unfortunately, the results suggest that there are no easy answers; there is a serious need for better treatment methods not to mention greater prevention efforts.

The multi-center clinical trial involved nearly 700 children, ages 10 to 17, all of whom had developed type 2 diabetes within the last two years. Each young patient was randomly assigned to one of three treatments for a minimum of two years: the common diabetes drug metformin; a combination of metformin and another diabetes drug, rosiglitazone (Avandia); or a combination of metformin and an intensive lifestyle-intervention program, which encouraged significent dietary changes and increased exercise. After a minimum follow-up period of two years, only about half of the children were able to control their blood sugar with metformin alone, while 60 percent had success on a regimen of both metformin and rosiglitazone. The added lifestyle interventions did not appear to make any difference.

In an editorial accompanying the New England Journal study, Dr. David B. Allen, a pediatrician at the University of Wisconsin School of Medicine and Public Health, makes the case for improving both prevention and treatment strategies for childhood type 2 diabetes. The need is especially urgent, he asserts, considering that, among adolescents the percentage of newly diagnosed diabetes cases that are type 2 has increased from 3 percent to about 50 percent over the span of the past few decades.

Dr. Allen notes that the study s findings suggest that kids with type 2 diabetes may require a therapy that involves multiple oral medications or insulin therapy. Yet despite the failure of lifestyle intervention in this study, Dr. Allen believes that this approach should not be abandoned. He points to results suggesting that poor adherence to the lifestyle intervention is the real reason for its lack of significant effect. As he writes, Indeed, this is the essential, maddening conundrum of the epidemic of type 2 diabetes collective failure to adhere to a lifestyle healthy enough to prevent the disease.

So how to encourage such a lifestyle in a sedentary and calorically dense environment, Dr. Allen wonders? His brief conclusion nods at economic incentives to produce and purchase healthy foods and to build safe environments that require physical movement.

Dr. Ross is saddened by this report, and wonders, Why do our young people today seem to be bound to their screens and devices? I believe a good portion of the twin problems of obesity and diabetes stem from the sedentary nature of our society in this century, and teenagers are some of the primary victims. Of course, increased portion sizes and ever-cheaper high-calorie food are other factors, all of which are difficult to counter in a free society.