Obesity Related Type 2 Diabetes is More Severe in Teens than Adults

by Gary Pepper, M.D. and Andrew Levine, Pre-Med, Univ of Central Florida

The recently published TODAY study found obesity related type-2 diabetes mellitus (T2DM) is more severe as a teen than as an adult, and high risk of developing diabetes could be tied to weight gain at an early age.

Between 2004 and 2009 the “Treatment Options for Type 2 Diabetes in Youth Study Group” (TODAY) gathered 700 participants who met the American Diabetes Association’s criteria for this disease. The participants were monitored for between two to six years. TODAY’s goal was to assess treatment options and the clinical progression of obesity related T2DM in youth. The mean age of the 700 participants in the TODAY study was thirteen, the majority being female. Sixty percent of the 700 participants were African American or Hispanic, with the remainder being Caucasian. The mean duration of diabetes for the study’s’ participants was less than seven months. A major worrisome finding from the study is a majority of participants were also discovered to have dyslipidemia, an abnormally high amount of fats (cholesterol, triglycerides) in the blood, as well as high blood pressure (hypertension).

Many experts in the endocrine and diabetes fields believe that the onset of T2DM is more aggressive in youth than in adults. This is because the insulin making cells, the beta-cells, are damaged at a faster rate in youth compared to adults. Deterioration of beta cell function in youth was approximately four times greater than seen in adults with T2DM. Specifically during the study, there was a 20-35% decline in beta cell function for youths compared to a 7-11% increase in adults.

The TODAY study also found that children and adolescents with T2DM have a higher rate of progression of complications associated with their disease. For example, youths were found to have early signs of heart, kidney, and eye disease. After four years, the rate of kidney disease rose from 6.3% to 16.6% in youth which is much more rapid than in adults.

Unfortunately, the majority of drugs used to treat diabetic adults have not been studied enough in children and teens to be approved by the Food and Drug Administration. The most widely used of the diabetes pills used in adults, metformin, when used in youth, becomes rapidly ineffective with 50% eventually going on to insulin injections when the metformin no longer can control the disease. Surprisingly when the young diabetics were taking metformin together with rosiglitazone (Avandia), the need to go on insulin was reduced by 25%. The researchers believe this benefit is due to rosiglitazone’s ability to preserve beta cell function. Making matters more complicated is the controversy over Avandia’s association with heart attacks and stroke in adults. Restrictions on Avandia’s use have only just been lifted after years of uncertainty about its safety.

The organizers of the TODAY study concluded that it is vitally important to diagnose diabetes in children as early as possible. Pediatricians cannot presently detect the primary defect at an early stage in youth because of the difficulty in measuring loss of beta-cell function. A simple, inexpensive test for this early biomarker does not exist. A study called “Restoring Insulin Secretion (RISE)” hopes to find metabolic markers early on so that they can monitor the progression to T2 DM more accurately.

The risk of T2DM is linked to weight gain in the youth population. The organizers of The National Longitudinal Study of Adolescent Health, showed the timing of teen and young adult weight gain appears to be linked to the risk of developing diabetes. If the weight gain occurs at a younger age the risk of developing diabetes increases.

For example, if a twenty seven year old man with a BMI of 30 kg/m² gains eight BMI units between the ages of 15 and 20 (fifty pounds for someone 5 foot 8 inches tall), he is at a significantly greater risk for diabetes than if the increase of the same amount of weight occurred when he was just 5 to7 years older.

Due to the rapid rise in the rate of obesity in children, adolescents and young adults, experts are predicting that T2DM and its attendant complications of kidney, eye and heart disease will rise accordingly unless a substantial change in eating and exercise habits can be accomplished. Optimism is low as these trends are more likely to accelerate rather than reverse with increasing dependence on technology and lack of innovation in nutrition techniques.

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Unmasking the Dark Side of the Ozempic Craze

By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”

Off- Label Use

The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.

GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.