Decline in Beta-Cell Function Among Adolescents with Type 2 Diabetes Mellitus

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Alain Joffe, MD, MPH, FAAP reviewing Elder DA et al. J Adolesc Health 2017 Sep 18.

Adolescents with newly diagnosed T2DM had a 25% annual decline in beta-cell function despite receiving treatment.

Beta-cell function declines over time in adults with type 2 diabetes mellitus (T2DM), but whether this occurs in adolescents is uncertain. Investigators prospectively compared beta-cell functioning over time between 39 adolescents with newly diagnosed T2DM (mean age, 15 years; body-mass index z-score, 2.4) and 32 obese adolescents without T2DM of comparable body-mass index, gender, and race (mean age, 14) during a 2-year period.

All participants were in later stages of puberty (Tanner stage 4 or greater). More than half of adolescents with T2DM were being treated with insulin, and 80% were taking oral anti-T2DM medications. Beta-cell function, as measured by the disposition index (insulin secretion in response to an intravenous glucose load adjusted for insulin sensitivity) was assessed at baseline and 6, 12, and 24 months later.

At baseline, adolescents with T2DM had significantly higher levels of both insulin resistance and fasting glucose (116 vs. 85 mg/dL) compared with controls. The disposition index in patients with T2DM was only 10% of that of controls. During the 2-year study, adolescents with T2DM experienced a significant increase in fasting glucose and a 25% annual decline in disposition index, while both indicators remained unchanged among controls.

COMMENT These results are particularly concerning given that these adolescents with T2DM were receiving standard treatment for their illness and had hemoglobin A1c levels below 8% at each follow-up assessment. Over 90% of severely obese adolescents have reversal of their T2DM following bariatric surgery. Weight loss, which improves insulin sensitivity, hopefully would also result in slowing or reversing declining beta-cell function in adolescents with T2DM, though no evidence yet supports this.

 

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication

Editorial boards JAMA Pediatrics

CITATION(S):

Elder DA et al. β-cell function over time in adolescents with new type 2 diabetes and obese adolescents without diabetes. J Adolesc Health 2017 Sep 18; [e-pub]. (http://dx.doi.org/10.1016/j.jadohealth.2017.06.007)

 

 

da NEJM