Effect of early glycemic control in youth-onset type 2 diabetes on longer-term glycemic control and b-cell function: Results from the TODAY Study

Authors: NADEAU, KRISTEN - University Of Colorado; EL GHORMLI, LAURE - George Washington University; ARSLANIAN, SILVA - University Of Pittsburgh; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); CAPRIO, SONIA - Yale University; CHAN, CHRISTINE - Children'S Hospital - Denver, Colorado; CHAO, LILY - Children'S Hospital Los Angeles; RAYAS, MARIA - University Of Texas At San Antonio; SISKA, MAGGIE - Billings Clinic; ZEITLER, PHILIP - Children'S Hospital - Denver, Colorado

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/15/2023
Publication Date: 6/28/2023
Citation: Nadeau, K.J., El Ghormli, L., Arslanian, S., Bacha, F., Caprio, S., Chan, C., Chao, L.C., Rayas, M., Siska, M.K., Zeitler, P. 2023. Effect of early glycemic control in youth-onset type 2 diabetes on longer-term glycemic control and b-cell function: Results from the TODAY Study. Diabetes Care. 46(8):1507-1514. https://doi.org/10.2337/dc23-0560.
DOI: https://doi.org/10.2337/dc23-0560

Interpretive Summary: Little is known about the impact of early attainment of tight glucose control on long-term glycemic control in youth-onset type 2 diabetes, and whether early goo control of glucose can prevent the rapid decline in insulin secretion in these children. This study in youth with type 2 diabetes involved in the TODAY study examined whether early good glucose control was protective of the pancreas insulin secretion ability over long-term follow-up of these teens into young adulthood. Researchers from Houston and others demonstrated that early glycemic control in the TODAY study translated to better long-term glycemic control. However, tight early glycemic control did not prevent deterioration of the pancreatic B-cell function. This indicates the need for better prevention of childhood-onset diabetes and different therapies to be introduced early in this age group.

Technical Abstract: Little is known about the impact of early attainment of tight glycemic control on long-term B-cell function and glycemic control in youth-onset type 2 diabetes. We examined the effect of the initial 6 months of glycemic control on B-cell function and glycemic control longitudinally over 9 years and the impact of sex, race/ethnicity, and BMI on these relationships in adolescents with youth-onset type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Oral glucose tolerance tests were performed longitudinally through year 9 to derive estimates of insulin sensitivity and secretion. Early glycemia was defined by mean HbA1c during the first 6 months postrandomization, categorized into five HbA1c groups (<5.7%, 5.7 to <6.4%, 6.4 to <7.0%, 7.0 to <8.0%, and >/-8.0%). The long-term period was defined as the period between years 2 and 9. A total of 656 participants (64.8% female, baseline mean age 14 years, diabetes duration <2 years) had longitudinal data available over an average of 6.4 +/- 3.2 years of follow-up. HbA1c significantly increased in all early glycemic groups during years 2-9, with a steeper increase (+0.40%/year) among participants with the tightest initial control (mean early HbA1c <5.7%), in parallel to a decline in the C-peptide-derived disposition index. Nevertheless, the lower HbA1c categories continued to have relatively lower HbA1c over time. Early tight glycemic control in the TODAY study was related to B-cell reserve and translated to better long-term glycemic control. However, tight early glycemic control on the randomized treatment in the TODAY study did not prevent deterioration of B-cell function.