Kids With Type 2 Diabetes: Combo Treatment Best?

Kids With Type 2 Diabetes: Combo Treatment Best?

Kids With Type 2 Diabetes: Combo Treatment Best?

April 29, 2012 -- The obesity epidemic has created a generation of children and teens who have type 2 diabetes, and a new study hints that the solution to this problem is not going to come easily.

Because type 2 diabetes among children is a relatively recent development, many treatment decisions have relied on what is known about adults with type 2 diabetes. Now, in the first major trial to compare treatments for the disease in young people, researchers have learned that two drugs are better than one for maintaining blood sugar control in these children.

Combined treatment with the diabetes drugs metformin and Avandia proved more effective than metformin alone or metformin plus lifestyle changes for keeping blood sugar at normal levels. Still, the combination failed to help more than a third of patients who took it.

The findings suggest that aggressive and early drug therapy may help children and teens with type 2 diabetes control their blood sugar levels and reduce the risk of complications such as heart disease, kidney failure, blindness, and nerve damage.

They also confirm that for many children with the disease, standard treatment with metformin alone is not enough, says Barbara Linder, MD, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Metformin is the only oral diabetes drug that has been approved by the FDA for use in children.

"These kids did not do as well on metformin as anticipated based on our experience in adults," she tells WebMD. "The assumption has been that kids will do fine on metformin, but clearly that is not the case."

Slideshow: Type 2 Diabetes Overview

Avandia Use Restricted During Trial

Closely linked to obesity, type 2 diabetes was almost unheard of in children just a few decades ago.

The obesity epidemic has changed this, however, and doctors have made troubling discoveries about early-onset type 2 diabetes, says pediatric endocrinologist and researcher Philip Zeitler, MD, PhD, of the Children's Hospital Colorado.

"We are learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly, which could be why metformin alone has a higher than expected failure rate," Zeitler says.

The finding that adding Avandia to metformin resulted in better outcomes raises more questions than it answers, since Avandia is no longer a treatment option for children and teens, says University of Wisconsin professor of pediatrics David B. Allen, MD.

In September of 2010, while the trial was under way, the FDA placed broad restrictions on Avandia's use following reports of heart attacks and strokes in adults taking the drug.

Participants in the Avandia part of the study continued taking the drug following a safety review, and no serious side effects were reported.