Youth-onset Type 2 Diabetes: Current Status, Challenges, and Priorities

October 20, 2015, Hilton Mark Center, Alexandria, VA, USA

Process

A full day meeting was convened of representatives from industry, academia, funding agencies, policy makers, advocacy groups and regulators. Presentations were given to provide background information on existing evidence and knowledge gaps. Following the presentations, a panel with audience participation examined the regulation, study design and outcome measures of pediatric research in type 2 diabetes (T2D). Following the in-person meeting, the key participants re-convened to summarize the state of knowledge and construct a consensus statement paper on challenges and priorities in youth-onset T2D.  This statement paper will appear in an upcoming issue of Diabetes Care.

Objectives

The objectives for this consensus conference were to review the current state of knowledge and controversies surrounding T2D in children, including understanding the fundamental similarities and differences between childhood and adult disease, the current therapeutic options, and to discuss the challenges and priorities for developing new approaches.

Statement of need

T2D is an emerging and devastating disorder in adolescents and young adults and there are unique challenges in studying as well as caring for these children. T2D disproportionately impacts youth from disadvantaged backgrounds and occurs in an environment where we don’t know how to deliver durable lifestyle change. The disordered lifestyle of these youth is not only the reason they get T2D, but also the reason they are difficult to treat, and the reason they are difficult to study.  Current approaches are not working and treatment options remain very limited. For example, we do not know how to help youth with T2D change their lifestyles, we have only 2 FDA approved drugs for T2D youth (insulin and metformin) despite many more being approved in adults, and we have been unable to complete drug trials of new agents in T2D youth. Therefore, we require clear strategies for research, prevention and treatment of diabetes in these vulnerable patients. Because our current approach is not working, we are not yet ready to publish updated treatment guidelines, and therefore a consensus conference was convened to begin to address the barriers to improving the lives of youth with T2D.

Evidence suggests that T2D in children differs in many ways from type 1 diabetes. However, it remains unclear exactly what facets are similar to adults with T2D and which facets are unique to youth with T2D. Clarifying whether T2D in youth is a fundamentally different disease or the same disorder just occurring earlier, is critical to deciding which aspects of the care of adults with T2D can be extrapolated to youth, and which areas require separate approaches. We don’t yet know how to best treat youth with T2D and need a better understanding of the biology. Numbers of youth in each country are relatively small, yet T2D in youth has an overwhelming impact on each youth, with large future financial repercussions to health care systems world-wide. Therefore, well-designed clinical trials with international cooperation are required. Understanding the unique pathophysiology of T2D in youth, as well as the risk of complications and the adverse psychosocial, economic and cultural milieu pediatric T2D occurs in, will enable industry, academia, funding agencies, advocacy groups, policy makers and regulators to collectively evaluate both current and future research, treatment and prevention approaches. The development of T2D in youth, a disorder that youth should be protected against, is like a canary in a mine signaling that something fundamental in society has gone wrong, thus cooperation with all stakeholders and international cooperation across borders is urgently required.

Collaborators

The American Academy of Pediatrics, the International Society for Pediatric and Adolescent Diabetes, and the Pediatric Endocrine Society were collaborating organizations with the American Diabetes Association.  A special thanks to Dr Kristen Nadeau, co-chair of the conference for providing this summary and overview.

 

 

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