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Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study
Author(s) -
Bacha Fida,
Pyle Laura,
Nadeau Kristen,
Cuttler Leona,
Goland Robin,
Haymond Morey,
Levitsky Lynne,
Lynch Jane,
Weinstock Ruth S.,
White Neil H.,
Caprio Sonia,
Arslanian Silva
Publication year - 2012
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/j.1399-5448.2011.00841.x
Subject(s) - medicine , family medicine , research center , glycemic , biostatistics , library science , gerontology , diabetes mellitus , public health , endocrinology , nursing , computer science , pathology
Objective To investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent‐onset type 2 diabetes (T2DM) at randomization in the TODAY study, the largest study of youth with T2DM to date. Methods We examined estimates of insulin sensitivity [1/fasting insulin (1/ I F ), fasting glucose/insulin ( G F / I F ), 1/fasting C‐peptide (1/ C F ), G F / C F ], β‐cell function [insulinogenic index (Δ I 30 /Δ G 30 ), and Δ C 30 /Δ G 30 ], and disposition index ( DI ) in the TODAY cohort of 704 youth (14.0 ± 2.0 yr; diabetes duration 7.8 ± 5.8 months; 64.9% female; 41.1% Hispanic, 31.5% Black, 19.6% White, 6.1% American Indian, and 1.7% Asian) according to hemoglobin A 1 c ( HbA 1 c ) quartiles at study randomization. The randomization visit followed a run‐in period (median 71 d) during which glycemic control ( HbA 1 c ≤ 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA 1 c levels before run‐in. Results Insulin secretion indices declined with increasing HbA 1 c quartiles, at randomization (Δ C 30 /Δ G 30 : 0.11 ± 0.09, 0.10 ± 0.19, 0.07 ± 0.06, and 0.03 ± 0.03 ng/mL per mg/dL, p < 0.0001; DI : 0.03 ± 0.03, 0.03 ± 0.05, 0.02 ± 0.02, and 0.01 ± 0.01 mg/dL −1 , p < 0.0001) and at screening, with no significant difference in insulin sensitivity. There were no significant differences in estimates of insulin sensitivity or secretion between genders or across the different racial groups. At randomization and screening, HbA 1 c correlated with DI (r = −0.3, p < 0.001), with Δ C 30 /Δ G 30 , but not with insulin sensitivity estimates. Conclusions In youth with recent‐onset T2DM treated with metformin, glycemic control, as measured by HbA 1 c , appears to be associated with residual β‐cell function and not insulin sensitivity.