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Management of hyperglycemia in minority children with type 2 diabetes mellitus.

This paper discusses management of hyperglycemia in minority children with type 2 diabetes mellitus (DM). Over the past several years the incidence of type 2 DM in minority children and adolescents has markedly increased. Intensive management of children with type 2 DM includes exercise, diet, insulin therapy, oral drug (metformin) therapy, and combination insulin-oral drug therapy. The results of a study of the efficacy of treatment modalities in 35 African-American children are presented. In the study, the patients were divided into two groups, one treated with diet or metformin therapy (20 children) and the other with insulin or a combination of insulin and metformin (15 children). All of the children in the study were negative for antibodies to glutamic acid decarboxylase. Plasma glucose and serum C-peptide concentrations were measured at 0, 30, 60, 90, and 120 min after ingestion of a liquid meal (Sustacal) (7 ml/kg with a maximum of 360 ml). The increase of C-peptide (ACP) in response to the mixed meal was calculated by peak minus fasting C-peptide. ACP was significantly higher in those children treated with diet/metformin than in those treated with insulin/insulin and metformin combination therapy (4.6 +/- 1.9 vs 21 +/- 1.6, p <0.01). Mean HbA1c at one-year follow up was lower for the diet/metformin patients than in the insulin/insulin and metformin group (7.0 +/- 2.8 vs 11.4 +/- 3.7, p <0.01). Our results indicate that in children with type 2 DM, there is more severe pancreatic beta-cell dysfunction in the group of children requiring insulin therapy.