title: Presentation and effectiveness of early treatment of type 2 diabetes in youth: lessons from the TODAY study.
abstract: OBJECTIVE
  The objectives were to (i) describe the characteristics of a large ethnically/racially and geographically diverse population of adolescents with recent-onset type 2 diabetes (T2D), and (ii) assess the effects of short-term diabetes education and treatment with metformin on clinical and biochemical parameters in this cohort.
  
  
  METHODS
  Descriptive characteristics were determined for subjects screened for Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) who met criteria for diagnosis of T2D (n = 1092). Changes in clinical and biochemical parameters were determined for those who completed at least 8 wk of the run-in phase of the trial, which included standardized diabetes education and treatment with metformin. Further analysis determined whether these changes differed according to the treatment at screening.
  
  
  METHODS
  Demographic, biochemical measurements, and anthropometrics at screening and changes over 8 wk of run-in were the outcome measures.
  
  
  RESULTS
  Subjects screened for TODAY had a median age of 14 yr and median hemoglobin A1c (HbA1c) of 6.9% (52 mM/M), 2/3 were female, and ethnic/racial minorities were overrepresented. Dyslipidemia and hypertension were common comorbidities. During run-in, HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and blood pressure significantly improved. Nearly all participants on insulin therapy at screening were able to attain target HbA1c following insulin discontinuation.
  
  
  CONCLUSIONS
  Treatment with metformin and diabetes education provided short-term improvements in glycemic control and cardiometabolic risk factors in a large adolescent T2D cohort. Nearly all insulin-treated youth could be successfully weaned off insulin with continued improvement in glycemic control.
authors.affiliation: Department of Pediatrics, University of Colorado, Aurora, CO, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Kelsey
authors.affiliation: The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Geffner
authors.affiliation: Department of Pediatric Endocrinology, Yale University, New Haven, CT, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Guandalini
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Department of Pediatric Endocrinology, Yale University, New Haven, CT, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: Department of Pediatrics, University of Colorado, Aurora, CO, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Zeitler
authors.affiliation: Department of Pediatrics, Washington University, St. Louis, MO, USA.
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
mesh_terms: D000293:Adolescent; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D010353:Patient Education as Topic; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: diabetes education; insulin therapy; metformin