Glycemic Control in Youth with Type 2 Diabetes Declines as Early as Two Years after Diagnosis

• Published in: The Journal of pediatrics Vol. 158; no. 1; pp. 100 - 105
• Main Authors: Levitt Katz, Lorraine E., MD, Magge, Sheela Natesh, MD, MSCE, Hernandez, Marcia L., DO, Murphy, Kathryn M., RN, PhD, McKnight, Heather M., CRNP, Lipman, Terri, CRNP, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 2011; Elsevier
• Subjects: Adolescent; adults; Biological and medical sciences; Blood Glucose; c-peptide; children; correlation; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; fasting; Female; Follow-Up Studies; General aspects; glycemic control; glycohemoglobin; Humans; Male; Medical sciences; noninsulin-dependent diabetes mellitus; Pediatrics; Prospective Studies; Time Factors; youth; T1DM; T2DM; DCC; Diabetic ketoacidosis; Diabetes Center for Children; Type 2 diabetes mellitus; Insulin-like growth factor binding protein-1; Body mass index; SD; IGFBP-1; Hemoglobin A1c; CHOP; Standard deviation; DKA; The Children's Hospital of Philadelphia; HbA1c; BMI; Type 1 diabetes mellitus; Endocrinopathy; Human; Type 2 diabetes; Target tissue resistance; Pediatrics; Adolescent; Metabolic diseases; Insulin resistance; Early stage; Diagnosis; Case history; Glycemia
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.07.011

Objectives To determine the course of glycemic decline in a pediatric cohort with type 2 diabetes mellitus (T2DM) by defining longitudinal changes in hemoglobin A1c (HbA1c) and insulin requirement. We also followed markers of insulin reserve (fasting C-peptide and IGFBP-1) over time. Study design Participants included two groups: (1) T2DM Nonacidotic (NA) (n = 46); and (2) T2DM diabetic ketoacidosis (n = 13). HbA1c, insulin dose, and fasting C-peptide and IGFBP-1 were obtained at baseline and every 6 months for 4 years. Results At baseline, Mann Whitney tests demonstrated that the diabetic ketoacidosis group had higher HbA1c ( P  = .002), required more insulin ( P = .036), and had lower C-peptide ( P = .003) than the NA group. Baseline insulin dose (Spearman r = -0.424, P = .009) and baseline IGFBP-1 (Spearman r = -0.349, P = .046) correlated negatively with C-peptide. Over time, HbA1c, insulin dose, and C-peptide changed significantly in a complex manner, with group differences. HbA1c reached a nadir at 6 to 12 months and began to rise after 1.5 years. Insulin requirements reached a nadir at 1 year and began to rise after 2 years. Conclusions Unlike adults, children with T2DM require increasing insulin doses over a 4-year period, and diabetic ketoacidosis at diagnosis predicts greater β-cell decline over time.