Double-drug diabetes treatment disappoints in kids

In a large new trial looking at ways to slow the progression of type 2 diabetes in children and teens, the addition of a second drug to the mainstay treatment metformin was only marginally more effective at controlling blood sugar than metformin alone.

Within a year, on average, half of kids on metformin and some 40 percent taking both metformin and rosiglitazone (Avandia) ended up having to resort to insulin injections to control their blood sugar, researchers reported Sunday at the annual meeting of the Pediatric Academic Societies in Boston and in the New England Journal of Medicine online.

"The results of the study were discouraging," said Dr. David Allen from the University of Wisconsin School of Medicine and Public Health in an NEJM editorial. "These data imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a very few years after diagnosis."

All 699 children included in the study had been diagnosed with type 2 diabetes two years or less before enrollment, so the rapid advance of about half to needing insulin marks an early start to a potential lifetime of complications and side effects - from the diabetes itself and the medications used to treat the disease.

Type 2 diabetes, the form usually associated with obesity, was once considered an "adult" disease, but is showing up in more and more teenagers, paralleling a rise in childhood obesity. And the condition is harder to treat in kids, experts say.

Type 2 diabetes "progresses more rapidly" in youth, according to Dr. Phil Zeitler from the University of Colorado, Denver, who worked on the new study.

He and his colleagues were surprised at how quickly many of the youngsters needed to switch from oral medications to taking daily insulin shots, Zeitler told Reuters Health.

Also, Zeitler said, the teens in the study appeared to have complications, including infections and hospitalization, more often than adults do.

All the children in the study were overweight or obese, and ranged in age from 10 to 17 years old.

Youngsters with diabetes are a difficult population to work with, Zeitler noted. Many of them don't take their medications as instructed. And in the first place, to get type 2 diabetes before adulthood, "the toxicity of your lifestyle must be pretty severe," Zeitler said.

That's why all of the kids in the study got at least "basic lifestyle counseling," he emphasized - for example, advice to stop drinking sugared sodas, eat less fast food, watch their diet in other healthy ways, take stairs instead of elevators and generally get more exercise.

Study enrollment began in July 2004 and follow-up continued through February 2011. All the kids in the study were taking metformin, a well-established diabetes drug, and a third were assigned to take the newer drug Avandia as well.