Influencing factors for treatment escalation from metformin monotherapy in youth-onset type 2 diabetes in Northern Taiwan

Yi-Hsuan Chou; Ya-Ting Su; Fu-Sung Lo; Chiao-Fan Chiu; Yen-Chun Huang

doi:10.1016/j.pedneo.2023.09.011

Influencing factors for treatment escalation from metformin monotherapy in youth-onset type 2 diabetes in Northern Taiwan

Pediatr Neonatol. 2024 Jan 3:S1875-9572(23)00248-6. doi: 10.1016/j.pedneo.2023.09.011. Online ahead of print.

Authors

Yi-Hsuan Chou¹, Ya-Ting Su², Fu-Sung Lo³, Chiao-Fan Chiu², Yen-Chun Huang²

Affiliations

¹ Department of Pediatrics, Chang Gung Memorial Hospital Keelung, Keelung, Taiwan; Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
² Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
³ Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: lofusu@cgmh.org.tw.

PMID: 38216419
DOI: 10.1016/j.pedneo.2023.09.011

Abstract

With the increasing prevalence of obesity, childhood type 2 diabetes (T2D) is a growing concern in Taiwan. Unlike its adult counterpart, T2D in children exhibits a more aggressive nature and earlier onset of complications. Metformin represents the first line of drug, but if blood sugar levels do not improve, other drugs are used. This retrospective cohort study endeavors to scrutinize and assess the pattern of treatment modification and associate factors among 79 young people with T2D in Taiwan. The study categorized participants into three distinct groups based on their treatment trajectory and outcomes: (1) those maintaining metformin (n = 34); (2) cases achieving remission (n = 7); and (3) individuals experiencing escalation through oral drugs or insulin (n = 38). The average follow-up period spanned 3.48 years. Findings from univariate analysis using a Cox proportional hazards model and propensity score weighting revealed that HbA1c and weight gain correlated with elevated risk of treatment escalation. Conversely, factors such as hypertension, high weight or body mass index (BMI) SDS, leptin levels, c-peptide concentrations, peak c-peptide values during glucagon stimulation test and LDL-cholesterol levels were associated with reduced risk of escalation. However, in multivariate analyses employing stepwise selection, the sole predictive factor for treatment escalation emerged as weight gain one year post-therapy (HR: 1.06, p < 0.001). This study underscores the interconnectedness between weight management and the trajectory toward either treatment escalation or disease remission. Furthermore, it highlights the cost-effective potential of intervening in younger populations. Ultimately, these insights accentuate the considerable opportunity for enhancing health care management strategies concerning pediatric T2D in Taiwan.

Keywords: Children; Metformin; Treatment; Type 2 diabetes.