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      Youth-onset type 2 diabetes mellitus: lessons learned from the TODAY study.

      1 , 2
      Mayo Clinic proceedings
      Elsevier BV

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          Abstract

          Type 2 diabetes mellitus is increasingly diagnosed in obese children and adolescents. Evidence suggests that this disease commonly progresses more rapidly in youth compared with adults and is associated with high rates of early microalbuminuria, hypertension, and dyslipidemia. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study was the first multiethnic, multicenter randomized trial in the United States to compare 3 treatment approaches in obese youth with new-onset type 2 diabetes (n=699; ages 10-17 years): monotherapy with metformin, metformin with rosiglitazone, and metformin with an intensive lifestyle intervention. The primary outcome was glycemic control. Diabetes-related complications and cardiovascular risk factors were also examined. Approximately half of the participants could not maintain glycemic control by using metformin alone. Combination therapy with metformin and rosiglitazone resulted in better durability of glycemic control, and metformin plus intensive lifestyle intervention was intermediate but not superior to metformin alone. Deterioration in glycemic control was associated with rapid loss of beta cell function, not worsened insulin sensitivity, and could not be explained by differences in adherence or body mass index. After 3.9 years, 236 (33.8%) of participants had hypertension and 116 participants (16.6%) had microalbuminuria. Only 55.9% of participants had a low-density lipoprotein cholesterol level less than 100 mg/dL (to convert to mmol/L, multiply by 0.0259) after 3 years, and 71 of 517 participants (13.7%) had retinopathy. The significance of the findings from this important trial for the management of youth and young adults with youth-onset type 2 diabetes and its complications is discussed. An aggressive multifaceted approach is needed to prevent or forestall premature microvascular and macrovascular complications in youth-onset type 2 diabetes.

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          Author and article information

          Journal
          Mayo Clin. Proc.
          Mayo Clinic proceedings
          Elsevier BV
          1942-5546
          0025-6196
          Jun 2014
          : 89
          : 6
          Affiliations
          [1 ] Department of Pediatrics, Case Western Reserve University, Cleveland, OH.
          [2 ] Department of Medicine, Upstate Medical University, Syracuse, NY. Electronic address: weinstor@upstate.edu.
          Article
          S0025-6196(14)00062-7 NIHMS582404
          10.1016/j.mayocp.2014.01.009
          4319667
          24702733
          381e22d6-cec2-4f04-8923-9542e149a9b5
          History

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