Type 2 diabetes in young people ages 10 to 19 has more than doubled in the past 20 years, but it remains difficult for doctors to predict who will be diagnosed and who will improve with treatment. A recently published study from the University of Oklahoma shows that measuring the abundance of circulating microRNAs (which affect insulin-producing beta cells in the pancreas) is probably as effective as measuring blood sugar in determining how well a young person With the condition you will do well.
Jeanie Tryggestad, MD, associate professor of pediatrics at OU School of Medicine, led the study, which is published in The Journal of Clinical Endocrinology and Metabolism. This is one of the first times that microRNA abundance has been explored to predict the progression of type 2 diabetes in young people. The specific microRNAs in the study are involved in insulin resistance and other actions that can stress beta cells or cause their death. The research is important because it points to a process that needs to be understood to ultimately design a prevention strategy.
“Type 2 diabetes in young people is very aggressive and the decline in beta cell function in young people is much greater than what we see in adults,” Tryggestad said. “We believe that predicting what will cause beta cell dysfunction, and eventually preventing that dysfunction, is one of the keys to preventing or treating type 2 diabetes.”
The Tryggestad study showed that microRNAs, at the start of the study, were almost as effective as measuring A1C (average blood sugar level) in predicting who would not respond to treatment for type 2 diabetes. Treatment failure was defined such as having an A1C greater than 8% for six months or a circumstance that caused the study participant to return to taking insulin without being able to stop taking it again. Circulating microRNAs also predicted a 20% decrease in beta cell function during the first six months of the study.
Currently, microRNAs can only be measured in a research setting, not a clinic, but that may change in the future, Tryggestad said. The implications of the study are important not only because of the predictive potential of microRNAs, but because they represent a mechanism or part of the process by which type 2 diabetes develops and worsens.
“Glucose and A1C are relevant to me as a doctor, but as a doctor-researcher, it is important to have this additional information about microRNAs because it tells us a mechanism. It is the mechanism that we need to understand to design a prevention strategy. “He adds a layer of understanding that we hadn’t had before,” he said.
Addressing the dramatic rise in type 2 diabetes in children is increasingly critical. Each year in the United States, cases of type 2 diabetes in young people increase by 5.3%. At that rate, prevalence is expected to increase by a staggering 700% by 2060. Tryggestad said that today, more young people ages 15 to 19 are living with type 2 diabetes than type 1 diabetes, the first time this happens. .
The samples analyzed in this research came from participants in the landmark TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study. The OU School of Medicine played a major role in the multicenter clinical trial, which began recruiting participants in 2003 and ended in 2020. The trial included 699 study participants, and Oklahoma enrolled more patients than any other participating site.
The trial was the first and largest of its kind to compare treatments for type 2 diabetes in young people, but it has continued to provide information since the original study ended. The OU School of Medicine received an additional grant to analyze microRNA samples taken during the first 10 years of the study.