Academic Journal
Main Category: Diabetes
Also Included In: Pediatrics / Children's Health
Article Date: 30 Apr 2012 - 9:00 PDT
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Controlling blood sugar in children and teenagers with diabetes type two is best achieved with a metformin plus rosiglitazone combo, compared to just metformin or metformin plus lifestyle changes, researchers reported in NEJM (New England Journal of Medicine). Blood-sugar control is also known as glycemic control, or blood glucose control.
There are very limited reliable data to guide treatment for young patients with diabetes type 2, even though rates in this age group have been rising over the last ten years. Over the last couple of decades, the prevalence of obesity among children in the USA has risen considerably.
In this study, the researchers compared the efficacy of three treatment regimes - they focused on durable glycemic control in pediatric patients who had recently been diagnosed with diabetes type 2.
699 patients aged from 10 to 17 years were initially treated with 1000 mg of metformin alone twice daily, until they achieved glycated hemoglobin levels of <8%. They were then randomly selected into three groups:
- Monotherapy metformin group - they continued on just metformin
- Combo metformin plus rosiglitazone (4 mg twice daily) group
- Metformin plus lifestyle-intervention program group - patients focused on diet to achieve ideal body weight, plus physical activity
The authors explained that the drug combo was considerably more effective than just metformin therapy, even though Avandia (rosiglitazone) usage has dropped somewhat in several parts of the world, mainly because of undesirable cardiovascular adverse events linked to its use in combination with TZD (thiazolidinedione) in adult patients.
The study had been designed before concerns regarding TZD type drugs emerged.
The researchers found that metformin on its own appears to offer incomplete and unsatisfactory therapy for many pediatric patients.
Lifestyle intervention also appeared not to be effective enough for a significant number of patients.
However, finding the ideal combination of the two drugs is vital, because thiazolidinediones are known to be associated with undesirable side effects in adults.
Over a mean follow-up of 3.86 years, the following percentages had treatment failure (glycated hemoglobin level of at least 8% for 6 months or sustained metabolic decompensation requiring insulin):
- 39% in the combination therapy group
- 52% in the monotherapy metformin group
- 47% in the metformin plus lifestyle intervention group
In an Abstract in the same journal, the researchers concluded:
"Monotherapy with metformin was associated with durable glycemic control in approximately half of children and adolescents with type 2 diabetes. The addition of rosiglitazone, but not an intensive lifestyle intervention, was superior to metformin alone."
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
MLA
Christian Nordqvist. "Metformin And Rosiglitazone Combo Best For Kids With Diabetes Type 2." Medical News Today. MediLexicon, Intl., 30 Apr. 2012. Web.
30 Apr. 2012. <http://www.medicalnewstoday.com/articles/244778.php>
APA
http://www.medicalnewstoday.com/articles/244778.php.
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