TY - JOUR
T1 - Lipid Profiles, Inflammatory Markers, and Insulin Therapy in Youth with Type 2 Diabetes
AU - TODAY Study Group
AU - Levitt Katz, Lorraine E.
AU - Bacha, Fida
AU - Gidding, Samuel S.
AU - Weinstock, Ruth S.
AU - El ghormli, Laure
AU - Libman, Ingrid
AU - Nadeau, Kristen J.
AU - Porter, Kristin
AU - Marcovina, Santica
AU - McKay, S.
AU - Haymond, M.
AU - Anderson, B.
AU - Bush, C.
AU - Gunn, S.
AU - Holden, H.
AU - Jones, S. M.
AU - Jeha, G.
AU - McGirk, S.
AU - Thamotharan, S.
AU - Cuttler, L.
AU - Abrams, E.
AU - Casey, T.
AU - Dahms, W.
AU - Ievers-Landis, C.
AU - Kaminski, B.
AU - Koontz, M.
AU - MacLeish, S.
AU - McGuigan, P.
AU - Narasimhan, S.
AU - Geffner, M.
AU - Barraza, V.
AU - Chang, N.
AU - Conrad, B.
AU - Dreimane, D.
AU - Estrada, S.
AU - Fisher, L.
AU - Fleury-Milfort, E.
AU - Hernandez, S.
AU - Hollen, B.
AU - Kaufman, F.
AU - Law, E.
AU - Mansilla, V.
AU - Miller, D.
AU - Muñoz, C.
AU - Ortiz, R.
AU - Ward, A.
AU - Wexler, K.
AU - Xu, Y. K.
AU - Yasuda, P.
AU - Hale, D.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/5
Y1 - 2018/5
N2 - Objectives: Data regarding atherogenic dyslipidemia and the inflammation profile in youth with type 2 diabetes is limited and the effect of insulin therapy on these variables has not previously been studied in youth. We determined the impact of insulin therapy on lipid and inflammatory markers in youth with poorly controlled type 2 diabetes. Study design: In the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multicenter trial, 285 participants failed to sustain glycemic control on randomized treatment (primary outcome, glycated hemoglobin A1c [HbA1c] at ≥8% for 6 months); 363 maintained glycemic control (never reached primary outcome). Statins were used for a low-density lipoprotein cholesterol of ≥130 mg/dL. Upon reaching the primary outcome, insulin was started. Changes in lipids and inflammatory markers (slopes over time) were examined. Results: Progression of dyslipidemia was related to glycemic control. In those with the primary outcome, insulin therapy impacted HbA1c modestly, and dampened the increase in total cholesterol, low-density lipoprotein cholesterol, and total apolipoprotein B, although statin use increased from 8.6% to 22% year after the primary outcome. The increase in triglycerides and plasma nonesterified fatty acids stabilized after insulin was started, independent of HbA1c. There was an increase in high-sensitivity C-reactive protein that continued after insulin initiation, related to HbA1c and percent overweight. Conclusions: Worsening dyslipidemia and inflammation over time raise concern regarding premature development of atherosclerosis in youth with type 2 diabetes. Insulin therapy has a limited benefit in the absence of glycemic control. Strategies to achieve better glycemic control are needed. Trial registration: ClinicalTrials.gov: NCT00081328.
AB - Objectives: Data regarding atherogenic dyslipidemia and the inflammation profile in youth with type 2 diabetes is limited and the effect of insulin therapy on these variables has not previously been studied in youth. We determined the impact of insulin therapy on lipid and inflammatory markers in youth with poorly controlled type 2 diabetes. Study design: In the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multicenter trial, 285 participants failed to sustain glycemic control on randomized treatment (primary outcome, glycated hemoglobin A1c [HbA1c] at ≥8% for 6 months); 363 maintained glycemic control (never reached primary outcome). Statins were used for a low-density lipoprotein cholesterol of ≥130 mg/dL. Upon reaching the primary outcome, insulin was started. Changes in lipids and inflammatory markers (slopes over time) were examined. Results: Progression of dyslipidemia was related to glycemic control. In those with the primary outcome, insulin therapy impacted HbA1c modestly, and dampened the increase in total cholesterol, low-density lipoprotein cholesterol, and total apolipoprotein B, although statin use increased from 8.6% to 22% year after the primary outcome. The increase in triglycerides and plasma nonesterified fatty acids stabilized after insulin was started, independent of HbA1c. There was an increase in high-sensitivity C-reactive protein that continued after insulin initiation, related to HbA1c and percent overweight. Conclusions: Worsening dyslipidemia and inflammation over time raise concern regarding premature development of atherosclerosis in youth with type 2 diabetes. Insulin therapy has a limited benefit in the absence of glycemic control. Strategies to achieve better glycemic control are needed. Trial registration: ClinicalTrials.gov: NCT00081328.
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U2 - 10.1016/j.jpeds.2017.12.052
DO - 10.1016/j.jpeds.2017.12.052
M3 - Article
C2 - 29398050
AN - SCOPUS:85041917429
SN - 0022-3476
VL - 196
SP - 208-216.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -