Struggling to find a fix for type 2 diabetes

Treatments for both adults and children need to change to avoid a type 2 diabetes epidemic, researchers say.

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Intervening aggressively to roll back the onset of type 2 diabetes does works in adults, but once the medication and treatment ends, the disease always returns, according to a study published today in the journal Diabetes Care.

UW Medicine’s Dr. Steven Kahn, the study chair of the NIH multicenter Restoring Insulin Secretion (RISE) Study, said researchers were hoping that early, aggressive treatment of adults with prediabetes or new onset type 2 diabetes might turn back or slow the disease. But that’s not what the results showed.

“The RISE medication studies show that these treatments for prediabetes or recently diagnosed type 2 diabetes do not make lasting changes to beta cells,” which control insulin production and release," he said. Kahn is a professor of medicine, Division of Metabolism, Endocrinology, and Nutrition, at the University of Washington School of Medicine. He is also an endocrinologist at VA Puget Sound Health Care System.

“For adults we’re seeing no sustained improvements in insulin release in any of the treatment groups, and we need to start rethinking what approaches we might want to use,” said Kahn.

He added, "For youth, we are seeing a much more adverse trajectory with regards to insulin secretion."

Doctors and researchers need to get a grasp of how to push back this disease “if we’re going to stem what I think will be an epidemic of type 2 diabetes in younger individuals,” he said.

Kahn was referring to one of two NIH studies which occurred over the past year.  The studies looked at medical treatments of prediabetes and type 2 diabetes for adults.

This study is a follow up to a 2018 RISE study conducted by the NIH. That study, which focused on youth treatment, found that medicines used to treat diabetes in adults were not effective on youth. Researchers said that finding was disturbing, because type 2 diabetes among youth is a growing problem.

This research, funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and based partly at VA Puget Sound Health Care System and University of Washington Medical Center, was published June 9 in the journals Diabetes and Diabetes Care. Findings were presented today at the American Diabetes Association Scientific Sessions in San Francisco.

The RISE Adult and Pediatric Medication Studies compared the use of different treatments among adults aged 20 to 65 and youth aged 10 to19  who had impaired glucose tolerance or early onset type 2 diabetes. The aim was to preserve beta cell function, which is key to the body’s ability to make and release insulin.

In the adult study, the results of which were published in Diabetes Care, participants were randomly assigned to receive either long-acting insulin (glargine) for three months followed by nine months of metformin, the drug liraglutide in combination with metformin for 12 months, metformin alone for 12 months, or a placebo.

The researchers wanted to see whether early aggressive treatment could have a lasting effect on slowing or stopping the decline of beta cell function that occurs in people with prediabetes and recent onset type 2 diabetes. Participants were monitored for three more months after treatments ended. 

Results showed that adult participants had improvements in beta cell function and blood glucose control while on the treatments, with those in the liraglutide plus metformin group showing the most improvement after 12 months. However, these improvements faded among all of the groups after treatment ended.

In a companion paper, published in Diabetes, findings from the adult study were compared to those from the RISE Pediatric Medication Study published in 2018. That study showed that beta cell function declined in the two youth treatment groups during active treatment, and worsened after treatment ended.

The RISE Adult and Pediatric Medication Studies were designed together to directly compare the effect of treatment on youth and on adults.

NIH support for RISE comes primarily through NIDDK awards U01DK94430, U01DK94431, U01DK94406, U01DK94438 and U01DK094467, with additional support from the NIH’s National Center for Advancing Translational Sciences. The Department of Veterans Affairs, University of Washington School of Medicine, Kaiser Permanente Southern California, and the American Diabetes Association also supported the studies, with additional donations of supplies from Allergan Corporation, Apollo Endosurgery, Abbott Laboratories, and Novo Nordisk A/S.


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