Location: Children's Nutrition Research CenterTitle: Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study) Author
Submitted to: Pediatric Diabetes
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/17/2011
Publication Date: 8/1/2012
Citation: Bacha, F., Pyle, L., Nadeau, K., Cuttler, L., Goland, R., Haymond, M., Levitsky, L., Lynch, J., Weinstock, R.S., White, N.H., Caprio, S., Arslanian, S. 2012. Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study. Pediatric Diabetes. 13(5):377-384. Interpretive Summary: In children with diabetes, it is important to keep blood sugars in a good range. This study investigated the factors responsible of controlling the blood sugar level in children with type 2 diabetes. We found that the ability of the body to make insulin (a substance that helps the body use sugar) is the most important factor to keep diabetes under control. This suggests that future research should try to find out ways to preserve insulin production in children with type 2 diabetes.
Technical Abstract: The purpose of this study was to investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent-onset type 2 diabetes (T2DM) at randomization in the TODAY study, the largest study of youth with T2DM to date. We examined estimates of insulin sensitivity [1/fasting insulin (1/I(F)), fasting glucose/insulin (G(F)/I(F)), 1/fasting C-peptide (1/C(F)), G(F)/C(F)], beta-cell function [insulinogenic index (delta I(30)/delta G(30)), and delta C(30)/delta G(30)], and disposition index (DI) in the TODAY cohort of 704 youth (14.0 +/- 2.0 yr; diabetes duration 7.8 +/- 5.8 months; 64.9% female; 41.1% Hispanic, 31.5% Black, 19.6% White, 6.1% American Indian, and 1.7% Asian) according to hemoglobin A1c (HbA1c) quartiles at study randomization. The randomization visit followed a run-in period (median 71 d) during which glycemic control (HbA1c </= 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels before run-in. Insulin secretion indices declined with increasing HbA1c quartiles, at randomization (delta C(30)/delta G(30) : 0.11 +/- 0.09, 0.10 +/- 0.19, 0.07 +/- 0.06, and 0.03 +/- 0.03 ng/mL per mg/dL, p < 0.0001; DI: 0.03 +/- 0.03, 0.03 +/- 0.05, 0.02 +/- 0.02, and 0.01 +/- 0.01 mg/dL(-1), p < 0.0001) and at screening, with no significant difference in insulin sensitivity. There were no significant differences in estimates of insulin sensitivity or secretion between genders or across the different racial groups. At randomization and screening, HbA1c correlated with DI (r = -0.3, p < 0.001), with delta C(30)/delta G(30), but not with insulin sensitivity estimates. In youth with recent-onset T2DM treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual beta-cell function and not insulin sensitivity.