Type 2 Diabetes Research: What’s Next?
November is American Diabetes Month! To help raise awareness of this complex disease, Mitchell Geffner, MD, division chief of the Center for Endocrinology, Diabetes, and Metabolism at Children’s Hospital Los Angeles, answered a few questions about the past, present and future of type 2 diabetes research.
Why is it important to study Type 2 diabetes mellitus in children?
Type 2 diabetes mellitus (T2DM) in youth has recently emerged as a worldwide disease and is a looming public health crisis, considering the life-long disease burden and risk for accelerated development of micro- and macrovascular complications. These complications affect youth with T2DM more than adults with T2DM.
What exactly are micro-and macrovascular complications?
Microvascular complications are those that affect the small blood vessels—the most common being diabetic retinopathy, which damages the blood vessels of the retina and can cause blindness. Macrovascular complications include coronary artery disease and stroke.
In order to develop better treatment options for young patients, the multi-center Treatment Options for Diabetes in Adolescents and Youth (TODAY) Study was conceived in 2004. Children’s Hospital Los Angeles is one of the most active centers. What does the TODAY study do for T2DM research?
Through the TODAY study, 15 centers across the country have been examining the efficacy of different approaches to treat recently-diagnosed T2DM youth, ages 10-17 years.
We are now participating in an extension study known as TODAY2 , in which we follow our original subjects long-term. This way, we can monitor for complications in the different treatment groups and determine if their initial therapy in the TODAY study predicts their future health outcomes in any way.
What research developments have you recently been a part of?
In one recent TODAY-related publication in which I was involved, we reported that exposure to major stressful life events is associated with lower adherence to prescribed oral medication regimens and impaired psychosocial functioning in adolescents with T2DM.
Where do you think type 2 diabetes research is headed in the next 5 years? Is there any particular aspect of the disease that researchers are focusing on?
The next phase of pediatric T2DM diabetes research will involve development of new drug therapies and/or studies of therapies already available to adults with T2DM to youth with the disease. What we have learned from the TODAY study is that combinations of drugs will assuredly be required to optimize treatment. Hopefully, over the next 5 years, basic science research will uncover the underlying cause of T2DM which offers the best opportunity for prevention, treatment, and cure.