Expert: We can delay the onset of diabetes in youths
LOS ANGELES — Liraglutide is effective in lowering HbA1c and should be considered to prevent progression to type 2 diabetes among children, according to a diabetes expert here at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease.
The approval of liraglutide (Victoza, Novo Nordisk) is a “new era,” said Sonia Caprio, MD, of the department of pediatrics at Yale School of Medicine. “I have hope … that we can delay the onset of diabetes in children.”
Caprio reminded audiences that in the 2012 TODAY Study Group trial, more than half of the children did not respond to metformin, which was the “classic drug we all started children on when we diagnose them with type 2 diabetes.”
“It is like they were treated with water,” she said.
Caprio critiqued the American Diabetes Association guideline on how to treat type 2 diabetes among youths because the advice continued to be to start patients on metformin. [Endocrine Today reported on Aug. 1 that the ADA revised its guideline. This report can be read here.]
“The uniqueness of RISE was that we employed a very sophisticated technique to measure insulin secretion and sensitivity while they were being treated,” Caprio said, and the study determined that aggressive, early treatment with insulin and metformin was unlikely to slow progression of diabetes.
Caprio shared her take on the ELLIPSE study, which found that adding a regimen of 1.8 mg per day of liraglutide to metformin therapy can better reduce HbA1c levels for children with type 2 diabetes compared with metformin alone, according to findings published in The New England Journal of Medicine.
“So why don’t we use [liraglutide] to stop the onset of type 2 diabetes in kids?” Caprio asked. “Because I think this is a preventable problem. We should end type 2 diabetes in youth. This is doable. But we will be doing it, in my opinion, with drugs.”
Caprio spoke about the challenges of the gastrointestinal effects of liraglutide and noncompliance.
“Children, teenagers — some of them are not taking the medication,” she said. “That’s the age. We have to deal with that.”
“Finally, we have something … to at least delay the complications,” she said.
Caprio S. The challenge of managing youth-onset T2DM with currently approved medications: Time to change strategies. Presented at: World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease; Dec. 4-7, 2019; Los Angeles.
Disclosure: Caprio reports no relevant financial disclosures.