Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study

Fida Bacha, Laura Pyle, Kristen Nadeau, Leona Cuttler, Robin Goland, Morey Haymond, Lynne Levitsky, Jane L Lynch, Ruth S. Weinstock, Neil H. White, Sonia Caprio, Silva Arslanian

Research output: Contribution to journalArticle

27 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)377-384
Number of pages8
JournalPediatric Diabetes
Volume13
Issue number5
DOIs
StatePublished - Aug 2012
Externally publishedYes

Fingerprint

Random Allocation
Type 2 Diabetes Mellitus
Insulin Resistance
Hemoglobins
Fasting
Metformin
Insulin
Glycemic Index
Asian Americans
C-Peptide
Hispanic Americans
Glucose

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

Bacha, F., Pyle, L., Nadeau, K., Cuttler, L., Goland, R., Haymond, M., ... Arslanian, S. (2012). Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study. Pediatric Diabetes, 13(5), 377-384. https://doi.org/10.1111/j.1399-5448.2011.00841.x

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 journalArticle

Bacha, F, Pyle, L, Nadeau, K, Cuttler, L, Goland, R, Haymond, M, Levitsky, L, Lynch, JL, Weinstock, RS, White, NH, Caprio, S & Arslanian, S 2012, 'Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study', Pediatric Diabetes, vol. 13, no. 5, pp. 377-384. https://doi.org/10.1111/j.1399-5448.2011.00841.x
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. / Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study. In: Pediatric Diabetes. 2012 ; Vol. 13, No. 5. pp. 377-384.
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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.",
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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

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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.

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KW - Disposition index

KW - Glycemic control

KW - Insulin secretion

KW - Insulin sensitivity

KW - Youth type 2 diabetes

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