Lipid Profiles, Inflammatory Markers, and Insulin Therapy in Youth with Type 2 Diabetes

TODAY Study Group

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)208-216.e2
JournalJournal of Pediatrics
Volume196
DOIs
StatePublished - May 1 2018

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Type 2 Diabetes Mellitus
Insulin
Lipids
Dyslipidemias
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hemoglobins
LDL Cholesterol
Therapeutics
Inflammation
Glycosylated Hemoglobin A
Apolipoproteins B
Nonesterified Fatty Acids
C-Reactive Protein
Multicenter Studies
Atherosclerosis
Triglycerides
Cholesterol

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{9a338782a2144cff919456d039382c04,
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.",
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 Xu, {Y. K.} and P. Yasuda and Daniel Hale",
year = "2018",
month = "5",
day = "1",
doi = "10.1016/j.jpeds.2017.12.052",
language = "English (US)",
volume = "196",
pages = "208--216.e2",
journal = "Journal of Pediatrics",
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}

Lipid Profiles, Inflammatory Markers, and Insulin Therapy in Youth with Type 2 Diabetes. / TODAY Study Group.

In: Journal of Pediatrics, Vol. 196, 01.05.2018, p. 208-216.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lipid Profiles, Inflammatory Markers, and Insulin Therapy in Youth with Type 2 Diabetes

AU - TODAY Study Group

AU - Levitt Katz, Lorraine E.

AU - Bacha, Fida

AU - Gidding, Samuel S.

AU - Weinstock, Ruth S.

AU - El ghormli, Laure

AU - Libman, Ingrid

AU - Nadeau, Kristen J.

AU - Porter, Kristin

AU - Marcovina, Santica

AU - McKay, S.

AU - Haymond, M.

AU - Anderson, B.

AU - Bush, C.

AU - Gunn, S.

AU - Holden, H.

AU - Jones, S. M.

AU - Jeha, G.

AU - McGirk, S.

AU - Thamotharan, S.

AU - Cuttler, L.

AU - Abrams, E.

AU - Casey, T.

AU - Dahms, W.

AU - Ievers-Landis, C.

AU - Kaminski, B.

AU - Koontz, M.

AU - MacLeish, S.

AU - McGuigan, P.

AU - Narasimhan, S.

AU - Geffner, M.

AU - Barraza, V.

AU - Chang, N.

AU - Conrad, B.

AU - Dreimane, D.

AU - Estrada, S.

AU - Fisher, L.

AU - Fleury-Milfort, E.

AU - Hernandez, S.

AU - Hollen, B.

AU - Kaufman, F.

AU - Law, E.

AU - Mansilla, V.

AU - Miller, D.

AU - Muñoz, C.

AU - Ortiz, R.

AU - Ward, A.

AU - Wexler, K.

AU - Xu, Y. K.

AU - Yasuda, P.

AU - Hale, Daniel

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.jpeds.2017.12.052

DO - 10.1016/j.jpeds.2017.12.052

M3 - Article

VL - 196

SP - 208-216.e2

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -