Baseline Predictors of Glycemic Worsening in Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study

• Published in: Diabetes care Vol. 44; no. 9; pp. 1938 - 1947
• Main Authors: Sam, Susan, Edelstein, Sharon L, Arslanian, Silva A, Barengolts, Elena, Buchanan, Thomas A, Caprio, Sonia, Ehrmann, David A, Hannon, Tamara S, Tjaden, Ashley Hogan, Kahn, Steven E, Mather, Kieren J, Tripputi, Mark, Utzschneider, Kristina M, Xiang, Anny H, Nadeau, Kristen J
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.09.2021
• Subjects: Adolescent; Adults; Age; Antidiabetics; Beta cells; Blood Glucose; Child; Chromium; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Glucose; Glucose Intolerance - diagnosis; Glucose tolerance; Glucose Tolerance Test; Humans; Hyperglycemia; Insulin; Insulin Resistance; Insulin Secretion; Medical diagnosis; Metformin; Research design; Secretion; Young Adult
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc21-0027

To identify predictors of glycemic worsening among youth and adults with impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes in the Restoring Insulin Secretion (RISE) Study. A total of 91 youth (10-19 years) were randomized 1:1 to 12 months of metformin (MET) or 3 months of glargine, followed by 9 months of metformin (G-MET), and 267 adults were randomized to MET, G-MET, liraglutide plus MET (LIRA+MET), or placebo for 12 months. All participants underwent a baseline hyperglycemic clamp and a 3-h oral glucose tolerance test (OGTT) at baseline, month 6, month 12, and off treatment at month 15 and month 21. Cox models identified baseline predictors of glycemic worsening (HbA increase ≥0.5% from baseline). Glycemic worsening occurred in 17.8% of youth versus 7.5% of adults at month 12 ( = 0.008) and in 36% of youth versus 20% of adults at month 21 ( = 0.002). In youth, glycemic worsening did not differ by treatment. In adults, month 12 glycemic worsening was less on LIRA+MET versus placebo (hazard ratio 0.21, 95% CI 0.05-0.96, = 0.044). In both age-groups, lower baseline clamp-derived β-cell responses predicted month 12 and month 21 glycemic worsening ( < 0.01). Lower baseline OGTT-derived β-cell responses predicted month 21 worsening ( < 0.05). In youth, higher baseline HbA and 2-h glucose predicted month 12 and month 21 glycemic worsening, and higher fasting glucose predicted month 21 worsening ( < 0.05). In adults, lower clamp- and OGTT-derived insulin sensitivity predicted month 12 and month 21 worsening ( < 0.05). Glycemic worsening was more common among youth than adults with IGT or recently diagnosed type 2 diabetes, predicted by lower baseline β-cell responses in both groups, hyperglycemia in youth, and insulin resistance in adults.