In the latter study, peripheral and autonomic neuropathy occurred at 21 and 57% of T2D teens, respectively . only recognized over the past few years, knowledge of its natural history is lacking, and there are only few studies analyzing treatments beyond metformin and insulin. Actually in case of the second option two medications, randomized controlled tests are very few, and knowledge is still accumulating with this field. One study whose results were published about the part of different treatment modalities in T2D is the treatment options for type 2 diabetes in youth (TODAY) study . This was a large, longitudinal, randomized, multicenter study that recruited 699 children and adolescents with an age range of 10C17 years and female to male ratio of 2?:?1. These patients were randomized to three treatment groups that included metformin alone or in combination with lifestyle intervention (LSI) or rosiglitazone. The mean time since BML-275 (Dorsomorphin) diagnosis of T2D was 7.8 months and HbA1c less than 8% on enrollment. The primary outcomes, defined as failure to maintain HbA1c less than 8% over 6 months or metabolic decompensation requiring insulin therapy at diagnosis or restarting after stopping insulin within 3 months, occurred in 51.7%, 46.6%, and 38.6% in the above groups, respectively . Metformin alone was no different from metformin plus LSI in improving metabolic outcomes, and higher failure rates in black participants were noted. Combination therapy of metformin plus rosiglitazone offered better success rates especially in girls but was associated with more weight gain. Despite intensive LSI, the rates of clinically important weight loss (7% or more) were achieved in only 24.3% in the metformin group, 31.2% in the metformin plus LSI groups, and in only 16.7% in the metformin plus rosiglitazone group . This study revealed that, even with intensive LSI and pharmacotherapy, a significant number of T2D patients fail to achieve adequate glycemic control. In addition, the treatment options available to youth with T2D are limited when compared to adults, with insulin and metformin being the main brokers used . Furthermore, rosiglitazone has been associated with unfavorable cardiac effects that lead to limited use in adult patients with T2D, although this has been recently questioned , but this limits its use in youth at this point. In this review, we will discuss the diagnosis and treatment of T2D in teens in view of the results of TODAY study. 2. Clinical Presentation of T2D in Children and Adolescents The average age of T2D diagnosis in youth is around 13.5 years, with female predominance. This age of presentation is likely to be related to a time BML-275 (Dorsomorphin) of puberty-mediated insulin resistance in combination with increased weight . The clinical presentation can Mmp7 be diverse. T2D can be detected while screening asymptomatic youth because of belonging to a high-risk populace . These risk factors include being overweight (BMI 85th percentile) or obese (BMI 95th percentile), family history in a first or second degree relative of T2D, being from certain ethnic groups known to have higher risk of T2D (Aboriginal, South Asian, Asian, African, and Hispanic), and history of in-utero exposure to obesity or hyperglycemia [7C9]. Additional risk factors that warrant screening for T2D include the presence of insulin resistance, for example, Acanthosis nigricans, dyslipidemia and hypertension, polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), and history of antipsychotic medication use [6C8]. The cost-benefit analysis for having a screening program for the general population is usually unjustified because of the low yield noted on several studies [10C14]. Screening in high-risk groups is recommended to start at the age of 10 years or when puberty starts if it is sooner than that, using fasting plasma glucose every 2 years. Oral glucose tolerance test can also be used but has poor reproducibility and is more expensive [6, 7]. Some children and adolescents present with diabetes-related symptoms including polyuria, polydipsia, tiredness, blurred vision, BML-275 (Dorsomorphin) vaginal moniliasis, and weight loss . They may also present with acute metabolic decompensation including ketosis, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic state . 3. Laboratory Diagnosis of T2D in Children and Adolescents The laboratory diagnosis of T2D in children uses the blood glucose cut-offs that are identical to adults and involves measuring fasting or random plasma glucose or a formal oral glucose tolerance test [7, 16, 17]. HbA1c is not recommended in the pediatric age group as a diagnostic test as is the case in adults but is used for follow-up in established.
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