Drugs for the treatment of pediatric type 2 diabetes mellitus and related co-morbidities

ABSTRACT

Introduction: The continuing global epidemic of obesity in adolescents has raised the prevalence of type 2 diabetes mellitus (T2DM). Despite the wealth of information concerning T2DM in adults, rare data are available targeting treatment of T2DM in pediatric.

Areas covered: This article has reviewed clinical practice guidelines, particularly the American Diabetes Association and the Pediatric Endocrine Society consensus, jointly with clinical trial data available in databases with respect to the use of available pharmacological options to treat T2DM and its complications in youth.

Expert opinion: The use of other pharmacological treatments of T2DM in addition to metformin and insulin entails several problems. Since rare studies have been conducted on the medications available to manage T2DM in children, treating them may be more difficult than that of adults. It needs longer and larger size clinical trials along with better pharmacological agents to affect various pathophysiological mechanisms of diabetes. Meanwhile, the efficacy and safety of combinations therapies should be completed in preclinical and clinical phases.

KEYWORDS:

• Pediatric
• treatment
• type 2 diabetes

Article highlights

• Future research priorities for the use of other hypoglycemic agents than metformin and insulin in youth with T2DM,

• Evaluation of synergistic effects of combinations of different hypoglycemic agents as one model to manage diabetes, firstly in animal models of T2DM and then in all 1–4 phases of clinical trials,

• Focusing on trials and/or discovering new pharmacological agents effective on other mechanisms of pathophysiology of diabetes such as oxidative stress. Some members of this group include edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one), benfotiamine, poly-ADPribose-polymerase inhibitors (nicotinamide) or interleukin-1 receptor antagonists (anakinra (kineret®)), ceramide synthesis inhibitors or activators of ceramide degradation and sphingosine modulators (S1P1,3,4,5R agonist), and fibroblast growth factor 21 (FGF21) [27].

• Evaluation of some plant-derived metabolites as an inexpensive and available source for discovering new drugs,

• More long-term clinical trials in overweight/obese youth with T2DM.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded