About half of adolescents with type 2 diabetes fail treatment with metformin alone within a few years. Things go somewhat better with metformin plus an intensive lifestyle intervention, and better still with the addition of rosiglitazone to metformin — however even the addition of the second drug leads to treatment failure about 40% of the time.

What’s to be done? On the basis of the evidence collected by the TODAY investigators, the problem has as many metabolic as social dimensions. Clearly, drugs alone are not the answer here.

Dr. Phil Zeitler, the TODAY study chair talks with Clinical Conversations about his surprise at the higher rate of failure with metformin monotherapy among adolescents than among adults, and what lessons this study holds.

Links:

Physician’s First Watch summary (free)

New England Journal of Medicine article (free)

New England Journal of Medicine editorial (free)