Type 2 diabetes (T2D) has always been referred to as “adult-onset,” and generally considered not to affect adolescents and youth. However, the recent child obesity epidemic has led to an increased incidence of T2D in children and adolescents from 10-19 years of age, as reported in papers and editorial commentaries in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study in the June issue of Diabetes Care.
The most surprising and alarming results of the TODAY study are the fast rate of disease progression of T2D in youth compared to progression in an adult, the high rate of co-morbidities and subsequent complications and the inadequate treatment options for this patient population.
The TODAY study is an ongoing study supported by the National Institute of Health, monitoring more than 500 youth with T2D since 2004. Participants were randomly assigned to one of three treatment groups: metformin alone, metformin plus rosiglitazone, or metformin plus intensive life-style changes. The study found that the rate of deterioration of beta cell function (cells in the body that produce insulin to help transfer glucose into cells) in youth with T2D was four times higher than adults and only the group in the metformin plus rosiglitazone achieved a significant improvement in the preservation of beta function and insulin sensitivity.
Additionally, high blood pressure, kidney disease, body mass composition, eye disease, and cardiovascular risk factors, including lipid and inflammatory markers increased in proportion to the rise in A1C (a protein indicating the severity of T2D) and over time. The development of T2D among youth has significant public health consequences, as the complications of diabetes in kidney, eye and cardiovascular disease will be manifested during the most active and productive periods of their lives.
So what can we do to help address this issue?
For starters, Enhanced External Counterpulsation (EECP®) Therapy can potentially help this cohort of patients by managing the glycemic control in young people. There are published studies in medical journals with data demonstrating that EECP can improve the delivery of glucose to muscle cells where it will be utilized effectively and reduce insulin resistance by activating the glucose transporter which helps insulin transport glucose into cells. Furthermore, there is sufficient evidence showing that EECP can improve endothelial function, producing factors that neutralize oxidative stress and inflammatory markers, while also reducing the co-morbid complications. These complications occur at higher rates in T2D youth because they will have a longer time to endure diabetic complications.
Currently, it is a working hypothesis that EECP Therapy may reduce the deleterious impact diabetes has in the young population and our health care system; additional clinical studies have to be done to confirm this hypothesis. Although EECP is not currently cleared by the FDA for the treatment of T2D, the potential is clear, and at Vasomedical, we are devoting more effort and resources toward researching the benefits of this treatment for this particular patient population.