written by Michael O’Leary

The news this week in the New England Journal of Medicine carried a double blow for parents of children diagnosed with type 2 diabetes. The first blow was finding that adding Avandia (rosiglitazone) or exercise to metformin was only slightly more effective at controlling blood sugar than metformin alone.

More disappointing than that, the researchers were surprised at how quickly many of the kids needed to switch to insulin injections to achieve blood sugar control.

As reported by MedPage Today, co-author Dr. Phil Zeitler, of the University of Colorado in Denver said that for some kids who are unable to get their blood sugar under control, adding Avandia may be beneficial. Determining who those kids may be however, may prove challenging as only a little more half of the kids in the study given the dual drug therapy achieved blood sugar control.

In the largest study to date of young people with type 2 diabetes, researchers compared three treatment options for 699 kids ages 10 to 17 who had been diagnosed for an average of 7.8 months. All were overweight or obese.

In one group the participants took only metformin, a second group took both metformin and Avandia, the third group underwent a rigorous program of exercise and diet in addition to taking metformin. All kids received basic lifestyle counseling including advice to stop drinking sugared sodas, reduce fast food consumption and exercise more.

The first patients began taking part in the study in July 2004 and the researchers followed them through February 2011, almost seven years. At the end, 52 percent of metformin alone group had treatment failure defined as having uncontrolled blood sugar for a period of six months or more. Among the metformin and Avandia group 39 percent had treatment failure and among those in the metformin and lifestyle intervention group 47 percent had treatment failure.

When they looked at the groups more closely, they found that the addition of Avandia seemed to only benefit girls, and the kids in the Avandia group gained the most weight during the study. Kids in the lifestyle group had the least weight gain.

It should be noted that since this study began, a number of newer drugs have been approved for blood sugar control, including GLP-1 drugs like Victoza and Byetta that have shown promise of being a more effective add-on to metformin not only for blood sugar control, but weight control.

In an editorial in the same issue, Dr. David Allen from the University of Wisconsin School of Medicine and Public Health, called the results disappointing on two levels.

“The results of the study were discouraging,” he wrote. “These data imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a very few years after diagnosis.”

Considering the steeply rising incidence of children with both obesity and type 2 diabetes, Allen concluded his editorial condemning the development of a calorie-laden sedentary culture that has arisen over the past few decades and pessimistically concludes that lifestyle interventions are not likely to succeed.

“Fifty years ago,” the editorial continues, “children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier ‘eat less, move more’ environment is created for today’s children, lifestyle interventions like that in the …study will fail.”