P-352: Pioglitazone monotherapy for treatment of youth-onset type 2 diabetes
J Wu, J Du, J Parris, M Moreno, P Zeitler, M Moriarty KelseyAbstract
Introduction
Youth-onset type 2 diabetes (YOT2D) is associated with rapid β-cell failure due to greater insulin resistance at onset than seen in adults. Early treatment with an insulin sensitizer is key. Adherence to metformin treatment can be challenging due to side effects. In the TODAY study, the thiazolidinedione (TZD) rosiglitazone was a beneficial add on with minimal adverse effects, yet little is known about the use of TZDs as a monotherapy in YOT2D.
Objectives
We aim to assess glycemia in our YOT2D population currently treated with metformin vs. the TZD pioglitazone, and to assess comorbidities in these treatment groups.
Methods
Youth seen in our T2D clinic since 2023 who were treated with either metformin or pioglitazone (+/- long-acting insulin) with at least a 6-month diabetes duration were included (n=98) in this cross-sectional analysis. Data were collected at the time of the most recent HbA1c. T-tests were performed to calculate group differences.
Results
Among the 102 patients (metformin=71, TZD=31), less than half (n=43, 42%) were male with a mean age of 17.4 (SD 2.8) years and diabetes duration of 29.9 (21.5) months. Table 1 shows descriptive data and the results. There was no difference in mean HbA1c (p=.0.52). In the group prescribed TZDs, BMI was higher (p=0.04) and triglycerides were lower (p=0.02). No other differences were found.
Conclusions
In 102 youth with an average diabetes duration of almost 2 years, monotherapy provides similar glycemic control to metformin, and may be more effective at treating hypertriglyceridemia. Given that pioglitazone is inexpensive, easy to take, and is not associated with gastrointestinal side-effects, it should be considered as an alternative insulin sensitizer in youth with type 2 diabetes.