Changes in Visceral and Subcutaneous Fat in Youth With Type 2 Diabetes in the TODAY Study
Year: 2019
Type: article
Abstract: OBJECTIVE In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, metformin plus rosiglitazone (M + R) maintained glycemic control better than metformin alone (M) or metformin plus lifestyle (M + L) in youth with type 2 diabetes (T2D). We hypothesized that changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) would explain the differential treatment effects on glycemia. RESEARCH DESIGN AND METHODS In 626 youth ages 11–17 years with T2D duration <2 years, VAT and SAT were estimated by DXA at baseline and at 6 and 24 months. Changes from baseline were analyzed in linear mixed models. RESULTS Baseline mean age was 13.9 years, 66.4% were female, 72.2% were Hispanic/non-Hispanic black, and 20.3% were non-Hispanic white (NHW). Mean BMI was 33.7 kg/m2. VAT increased more in M + R (13.1%) than M + L (3.9%, P = 0.0006) or M (6.5%, P = 0.0146). SAT also increased more in M + R (13.3%) than in M + L (5.4%, P < 0.0001) or M (6.4%, P = 0.0005), indicating no significant fat redistribution in M + R. In NHWs, VAT increased more in M + R than M (P = 0.0192) and M + L (P = 0.0482) but did not explain the race-ethnicity differences in treatment effects on glycemic control among treatment groups. VAT and SAT increases correlated with higher HbA1c, lower insulin sensitivity, and lower oral disposition index (all P < 0.05), but associations did not differ by treatment group. CONCLUSIONS In contrast to the existing reports in adults with T2D, in TODAY, M + R resulted in the most VAT accumulation compared with M + L or M. Differential effects on depot-specific indirect measures of adiposity are unrelated to treatment effects in sustaining glycemic control. Additional studies are needed to understand the clinical markers of metabolic risk profile in youth with T2D on rosiglitazone.
Source: Diabetes Care
DOI: 10.2337/dc18-1935
Institutions: SUNY Upstate Medical University, University of Hawaiʻi at Mānoa, University of Hawaii System, George Washington University, University of Oklahoma Health Sciences Center, Children's Hospital of Los Angeles, Saban Research Institute, University of Colorado Anschutz, Massachusetts General Hospital, Washington University in St. Louis
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1044130170, G130883262, G1415791185, Management of Pediatric Type 2 Diabetes Mellitus, Multi-Center Study of the Treatment of T2DM in Youth, G151374072, G1650331929, G1711233980, G1789861183, G1824217007, G2078309758, G2244966566, Case Western Reserve University/Cleveland Clinic CTSA (UL1), G2540315505, G2824222223, G299222429, G3374716125, Harvard Clinical and Translational Science Center (UL1), General Clinical Research Center, University of Pittsburgh Clinical and Translational Science Institute, The Next Generation of Innovative Cardiovascular Clinical/Translational Researchers, Type 2 Diabetes in Youth: Beta Cell Preservation, G413336477, G426894015, Treatment Alternatives in Pediatric Type 2 Diabetes, G475936976, TODAY2 Phase 2 (T2P2): Long-Term Post-Intervention Follow-Up, Institutional Clinical and Translational Science Award, G554783770, General Clinical Research Center, General Clinical Research Center, G733747580, Washington University Institute of Clinical and Translational Sciences (UL1), G800374514, Yale University Clinical and Translational Science Award Program, Clinical and Translational Science Collaborative of Cleveland, Washington University Nutrition Obesity Research Center, Yale Clinical and Translational Science Award, G903953877, Colorado Clinical and Translational Science Institute (UL1)
OpenAlex ID: W2948737848