@article{20e438bea18f4dbcaca7db8b06e4d514,
title = "Lipid Profiles, Inflammatory Markers, and Insulin Therapy in Youth with Type 2 Diabetes",
abstract = "Objectives: Data regarding atherogenic dyslipidemia and the inflammation profile in youth with type 2 diabetes is limited and the effect of insulin therapy on these variables has not previously been studied in youth. We determined the impact of insulin therapy on lipid and inflammatory markers in youth with poorly controlled type 2 diabetes. Study design: In the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multicenter trial, 285 participants failed to sustain glycemic control on randomized treatment (primary outcome, glycated hemoglobin A1c [HbA1c] at ≥8% for 6 months); 363 maintained glycemic control (never reached primary outcome). Statins were used for a low-density lipoprotein cholesterol of ≥130 mg/dL. Upon reaching the primary outcome, insulin was started. Changes in lipids and inflammatory markers (slopes over time) were examined. Results: Progression of dyslipidemia was related to glycemic control. In those with the primary outcome, insulin therapy impacted HbA1c modestly, and dampened the increase in total cholesterol, low-density lipoprotein cholesterol, and total apolipoprotein B, although statin use increased from 8.6% to 22% year after the primary outcome. The increase in triglycerides and plasma nonesterified fatty acids stabilized after insulin was started, independent of HbA1c. There was an increase in high-sensitivity C-reactive protein that continued after insulin initiation, related to HbA1c and percent overweight. Conclusions: Worsening dyslipidemia and inflammation over time raise concern regarding premature development of atherosclerosis in youth with type 2 diabetes. Insulin therapy has a limited benefit in the absence of glycemic control. Strategies to achieve better glycemic control are needed. Trial registration: ClinicalTrials.gov: NCT00081328.",
keywords = "adolescent, inflammatory markers, insulin, lipids, type 2 diabetes mellitus",
author = "{TODAY Study Group} and {Levitt Katz}, {Lorraine E.} and Fida Bacha and Gidding, {Samuel S.} and Weinstock, {Ruth S.} and {El ghormli}, Laure and Ingrid Libman and Nadeau, {Kristen J.} and Kristin Porter and Santica Marcovina and S. McKay and M. Haymond and B. Anderson and C. Bush and S. Gunn and H. Holden and Jones, {S. M.} and G. Jeha and S. McGirk and S. Thamotharan and L. Cuttler and E. Abrams and T. Casey and W. Dahms and C. Ievers-Landis and B. Kaminski and M. Koontz and S. MacLeish and P. McGuigan and S. Narasimhan and M. Geffner and V. Barraza and N. Chang and B. Conrad and D. Dreimane and S. Estrada and L. Fisher and E. Fleury-Milfort and S. Hernandez and B. Hollen and F. Kaufman and E. Law and V. Mansilla and D. Miller and C. Mu{\~n}oz and R. Ortiz and A. Ward and K. Wexler and J. Lynch and N. Amodei and D. Hale",
note = "Funding Information: Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/National Institutes of Health (NIH), which did not have any input on the study design or data analyses. This work was completed with funding from NIDDK/NIH grant numbers U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, U01-DK61254, and T32-DK063687; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children's Hospital Los Angeles), M01-RR00069 (University of Colorado Denver), M01-RR00084 (Children's Hospital of Pittsburgh), M01-RR01066 (Massachusetts General Hospital), M01-RR00125 (Yale University), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children's Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children's Hospital of Pittsburgh), UL1-RR024989 (Case Western Reserve University), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). S.G. receives research support from NIDDK for the TODAY study and from the NHLBI for the Cardio Study and serves on the scientific advisory board of the FH Foundation. R.W. receives grant support from the NIDDK, JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic, Novo Nordisk, Intarcia Therapeutics, Sanofi, Mylan GmbH Inc, and Joslin Diabetes Center. The other authors declare no conflicts of interest. Publisher Copyright: {\textcopyright} 2017 Elsevier Inc.",
year = "2018",
month = may,
doi = "10.1016/j.jpeds.2017.12.052",
language = "English (US)",
volume = "196",
pages = "208--216.e2",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",
}