Inpatient Education Tied to Glucose Control in Adolescents

LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.

Key factors associated with better glycemic control throughout the first 2 years of follow-up included:

▸ Initial treatment with insulin rather than an oral hypoglycemic agent.

▸ Inpatient, rather than outpatient, education at diagnosis.

▸ More frequent follow-up visits.

An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.

The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.

To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.

Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.

Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.

Their mean BMI was 36.4 kg/m

Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.

Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.

Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.

The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.

The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.

“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”

Dr. Kim and his associates reported no relevant financial disclosures.

LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.

Key factors associated with better glycemic control throughout the first 2 years of follow-up included:

▸ Initial treatment with insulin rather than an oral hypoglycemic agent.

▸ Inpatient, rather than outpatient, education at diagnosis.

▸ More frequent follow-up visits.

An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.

The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.

To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.

Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.

Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.

Their mean BMI was 36.4 kg/m

Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.

Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.

Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.

The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.

The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.

“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”

Dr. Kim and his associates reported no relevant financial disclosures.

LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.

Key factors associated with better glycemic control throughout the first 2 years of follow-up included:

▸ Initial treatment with insulin rather than an oral hypoglycemic agent.

▸ Inpatient, rather than outpatient, education at diagnosis.

▸ More frequent follow-up visits.

An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.

The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.

To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.

Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.

Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.

Their mean BMI was 36.4 kg/m

Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.

Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.

Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.

The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.

The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.

“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”

Dr. Kim and his associates reported no relevant financial disclosures.