Insulin, Education Key To Type 2 in Teens

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. 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.

Dr. Kim and 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

Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA_1c 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.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA_1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.

The steady increase in HbA_1c values between visit 3 and visit 8 was similarly less pronounced among 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 HbA_1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators 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. 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.

Dr. Kim and 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

Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA_1c 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.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA_1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.

The steady increase in HbA_1c values between visit 3 and visit 8 was similarly less pronounced among 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 HbA_1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators 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. 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.

Dr. Kim and 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

Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.

During a mean 5.6 follow-up visits, patients' mean HbA_1c 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.

“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA_1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.

The steady increase in HbA_1c values between visit 3 and visit 8 was similarly less pronounced among 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 HbA_1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators reported no relevant financial disclosures.