Abstract
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 (ΔI 30/ΔG 30), and ΔC 30/ΔG 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 A1c (HbA1c) quartiles at study randomization. The randomization visit followed a run-in period (median 71 d) during which glycemic control (HbA1c ≤ 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels before run-in. Results: Insulin secretion indices declined with increasing HbA1c quartiles, at randomization (ΔC 30/ΔG 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, HbA1c correlated with DI (r = -0.3, p < 0.001), with ΔC 30/ΔG 30, but not with insulin sensitivity estimates. Conclusions: In youth with recent-onset T2DM treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual β-cell function and not insulin sensitivity.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 377-384 |
| Number of pages | 8 |
| Journal | Pediatric Diabetes |
| Volume | 13 |
| Issue number | 5 |
| DOIs | |
| State | Published - Aug 2012 |
| Externally published | Yes |
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Keywords
- Disposition index
- Glycemic control
- Insulin secretion
- Insulin sensitivity
- Youth type 2 diabetes
ASJC Scopus subject areas
- Internal Medicine
- Pediatrics, Perinatology, and Child Health
- Endocrinology, Diabetes and Metabolism
Cite this
Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study. / Bacha, Fida; Pyle, Laura; Nadeau, Kristen; Cuttler, Leona; Goland, Robin; Haymond, Morey; Levitsky, Lynne; Lynch, Jane L; Weinstock, Ruth S.; White, Neil H.; Caprio, Sonia; Arslanian, Silva.
In: Pediatric Diabetes, Vol. 13, No. 5, 08.2012, p. 377-384.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study
AU - Bacha, Fida
AU - Pyle, Laura
AU - Nadeau, Kristen
AU - Cuttler, Leona
AU - Goland, Robin
AU - Haymond, Morey
AU - Levitsky, Lynne
AU - Lynch, Jane L
AU - Weinstock, Ruth S.
AU - White, Neil H.
AU - Caprio, Sonia
AU - Arslanian, Silva
PY - 2012/8
Y1 - 2012/8
N2 - 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 (ΔI 30/ΔG 30), and ΔC 30/ΔG 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 A1c (HbA1c) quartiles at study randomization. The randomization visit followed a run-in period (median 71 d) during which glycemic control (HbA1c ≤ 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels before run-in. Results: Insulin secretion indices declined with increasing HbA1c quartiles, at randomization (ΔC 30/ΔG 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, HbA1c correlated with DI (r = -0.3, p < 0.001), with ΔC 30/ΔG 30, but not with insulin sensitivity estimates. Conclusions: In youth with recent-onset T2DM treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual β-cell function and not insulin sensitivity.
AB - 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 (ΔI 30/ΔG 30), and ΔC 30/ΔG 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 A1c (HbA1c) quartiles at study randomization. The randomization visit followed a run-in period (median 71 d) during which glycemic control (HbA1c ≤ 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels before run-in. Results: Insulin secretion indices declined with increasing HbA1c quartiles, at randomization (ΔC 30/ΔG 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, HbA1c correlated with DI (r = -0.3, p < 0.001), with ΔC 30/ΔG 30, but not with insulin sensitivity estimates. Conclusions: In youth with recent-onset T2DM treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual β-cell function and not insulin sensitivity.
KW - Disposition index
KW - Glycemic control
KW - Insulin secretion
KW - Insulin sensitivity
KW - Youth type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84864381612&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864381612&partnerID=8YFLogxK
U2 - 10.1111/j.1399-5448.2011.00841.x
DO - 10.1111/j.1399-5448.2011.00841.x
M3 - Article
C2 - 22332798
AN - SCOPUS:84864381612
VL - 13
SP - 377
EP - 384
JO - Pediatric Diabetes
JF - Pediatric Diabetes
SN - 1399-543X
IS - 5
ER -