Findings from three studies provide new insight into preventing type 2 diabetes, potential triggers for type 1 diabetes in children, and glycemic control in today’s youth with type 2 diabetes. 

Study Shows Long-Term Prevention of Type 2 Diabetes Is Possible

Long-term follow-up of more than 2,000 people enrolled in the Diabetes Prevention Program Outcomes Study (DPPOS) indicates a continued significant reduction in the participants’ risk of developing type 2 diabetes. The DPPOS sought to evaluate the long-term effects of the Diabetes Prevention Program (DPP) interventions on type 2 diabetes and its complications. 

The DPP established the success of either an intensive lifestyle change program or treatment with metformin to prevent or delay type 2 diabetes in individuals at high risk for developing the disease. It found that lifestyle interventions, aimed at achieving weight loss, and metformin reduced the risk of type 2 diabetes by 58% and 31%, respectively, compared to a placebo after an average of three years. Metformin, one of the most commonly used medications worldwide for treating type 2 diabetes, is currently not labeled by the FDA to prevent diabetes, although it is approved in other countries.

The newest results of the DPPOS indicate that prevention effects in the original lifestyle change group and metformin treatment group remain 22 years after the start of the study with a 25% and 18% reduced risk of diabetes, respectively, compared with the original placebo group.

“I think it is important for providers and patients with prediabetes to know that even after 22 years, adults at a high risk for diabetes have continued to benefit from metformin or prior intensive lifestyle modification in preventing or delaying their risk of diabetes,” said Christine Lee, MD, DPPOS project scientist and program director in NIDDK’s Division of Diabetes, Endocrinology, and Metabolic Diseases. “In addition, other findings from the study presented at ADA highlight the importance of trying to further understand differences in how metformin or lifestyle modification work for select groups of adults at high risk for diabetes.”

The DPP lifestyle intervention program is offered in communities across the U.S. through the National Diabetes Prevention Program (NDPP) by the Centers for Disease Control and Prevention and through The Medicare Diabetes Prevention Program (MDPP), supported by the Center for Medicare and Medicaid Services, for Medicare beneficiaries.

For more information about the study, read the ADA press release.

Understanding Triggers of the Autoimmune Process Leading to Type 1 Diabetes in Children

Researchers from The Environmental Determinants of Diabetes in the Young (TEDDY) study, an international, multicenter trial researching the potential causes of type 1 diabetes in children, presented new results and information surrounding potential autoimmune "triggers" leading to type 1 diabetes and how they interact with genetic factors in children at-risk for developing the disease. 

Children who have type 1 diabetes have certain types of genetic changes, but not all children who have those changes develop diabetes. Something from the environment "triggers" the immune destruction of the beta cells of the pancreas that normally make insulin. TEDDY aims to discover viruses and nutritional factors that interact with genes to "trigger" the immune destruction of the beta cells, marked by islet autoantibodies appearing. The study enrolls infants "at-risk" for developing type 1 diabetes and follows them for 15 years to look for various beta-cell autoantibodies and diabetes to appear. TEDDY researchers have also found unique patterns of amino acids and lipids in children who later developed islet autoantibodies compared to those who did not, and have observed differences associated with the types of antibodies that developed first, and when they developed.

“The incidence of type 1 diabetes is rising worldwide, especially in the very young,” said Beena Akolkar, PhD, TEDDY project scientist and senior advisor in NIDDK’s Division of Diabetes, Endocrinology, and Metabolic Diseases. “Early findings from the TEDDY study have shed light on the heterogeneity of type 1 diabetes and shown that there are two different types of disease, depending on which autoantibody appears first in the disease process. This has changed our understanding of type 1 diabetes in children.”

For more information about the study, read the ADA press release.

Insight into the State of Youth with Type 2 Diabetes in the U.S.

Researchers revealed data from The SEARCH for Diabetes in Youth (SEARCH) study, which found that despite the rise of available diabetes technology, new therapies, and more aggressive glycemic targets, today's youth and young adults with diabetes in the U.S. are not demonstrating improved glycemic control compared to their counterparts from years past. Most notably, many age groups have worse glycemic control compared to youth and young adults from 2002–2007. 

The SEARCH study began in 2000 and represents the largest, most diverse study of diabetes in youth in the U.S., with more than 27,000 participants across racial and ethnic backgrounds from 10 different states.

Overall, youth and young adults with diabetes who had study visits between 2014 and 2019 had average A1C levels that were comparable to earlier SEARCH cohorts. However, current youth and young adults with type 1 diabetes in the 10–14, 15–19, and 20–24 age groups continue to have worse glycemic control than the 2002–2007 cohort. Similarly, participants 25 and older with type 2 diabetes tended to have worse glycemic control relative to earlier time periods.

"These results suggest that not all youth and young adults with diabetes are directly benefiting from the increased availability of diabetes technology, newer therapies, and the use of more aggressive glycemic targets for youth with diabetes over time," said the study's lead author Faisal Malik, MD, MSHS, assistant professor of pediatrics at the University of Washington School of Medicine, investigator at the Center for Child Heath, Behavior and Development at Seattle Children's Research Institute, and a pediatric endocrinologist at Seattle Children's Hospital. "Given the evidence highlighting the benefits of tight glycemic control, this study reinforces the need for interventions that combine the use of diabetes technology with effective behavioral and social approaches to improve A1C levels."

For more information about the study, read the ADA press release.