May 4, 2012

What Is Best for Young Type 2 Patients?

This was to have been part of my Friday tidbits, but this is getting fever pitched publicity so I am publishing this.

A youth study of type 2 diabetes patients to determine optimal potential glycemic control seems to have determined that a drug pulled from the market for adult type 2 patients is the drug of choice for our youth. The ages of people eligible for the study included youth from age of 10 to 17. In light of Avandia being pulled from the market, I have to wonder at the value of the study. Or, is this another attempt to bring it back on the market for the youth with type 2 diabetes. I can only hope this will not happen.

Realizing that the ages selected for the study is the age when our youth are trying to spread their own wings, find their own place in this world, and rightfully the most rebellious about authority, it is not surprising that overall failure rate is above 50 percent. I can also understand the need to establish evidence for clinical application in the treatment of young patients with type 2 diabetes.

The study was funded by the National Institutes of Health. Three groups were analyzed, one on metformin and Avandia, one on metformin only and one with metformin and intensive lifestyle intervention. None (that is right – none) of the groups did that striking well to clearly say one was better by far than the others. The two-drug regimen did do enough to be declared the better treatment option.

Some youth did lose weight at the start, but most did not and the majority actually gained some weight over the study period. Not a stellar performance by any standard. Read the results posted by NIH, and two articles in the New England Journal of Medicine here and here.

I am wondering, aloud or in writing if you prefer, why we expect our youth to lose weight on the information on food put out by the USDA and advocated by the American Diabetes Association, the Academy of Nutrition and Dietetics, the American Association of Clinical Endocrinologists, and the American Association of Diabetes Educators. Even a few nutritionists follow this, but more are finding it more important to actually teach nutrition and keep the preferred diet of many with diabetes nutritionally balanced rather than loaded with carbohydrates.

I also wonder why doctors prefer medications over any other form of treatment, when it is obvious that our youth needs to reduce their carbohydrates and whole grain consumption. Input some physical activity, less cell phone use, and less time spent sitting, and our youth may realize some real weight loss. There is some excellent discussion about this here. I am not a member so I can only read, but the discussion is good and some excellent points were raised.

Do keep your eyes open, this is making the rounds in the different medical circles and publications. Read the article in WebMD for a slightly different perspective. I suspect the newspapers will be featuring it also.

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