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Heavy teens get 'diabesity' warning

Overweight teenagers who develop diabetes will have a very tough time keeping it under control, according to new US research.

A major study tested several ways to manage blood sugar in teenagers newly diagnosed with diabetes and found that nearly half of them failed within a few years and one in five suffered serious complications.

The results spell trouble for a nation facing rising rates of "diabesity" - Type 2 diabetes brought on by obesity.

The government-funded study is the largest look yet at how to treat diabetes in teenagers. Earlier studies have mostly been in adults and most diabetes drugs are not even approved for youths.

The message is clear - prevention is everything, say experts. "Don't get diabetes in the first place," said Dr Phil Zeitler of the University of Colorado Denver, one of the study leaders.

A third of American children and teenagers are overweight or obese. They are at higher risk of developing Type 2 diabetes, in which the body cannot make enough insulin or use what it does make to process sugar from food. Until the obesity epidemic, doctors rarely saw children with Type 2 diabetes. The more common kind of diabetes in children is Type 1, which used to be called juvenile diabetes.

Doctors usually start Type 2 treatment with metformin, a pill to lower blood sugar. If it still cannot be controlled, other drugs and daily insulin shots may be needed. The longer blood sugar runs rampant, the greater the risk of suffering vision loss, nerve damage, kidney failure, limb amputation and even heart attacks and strokes.

The study involved 699 overweight and obese teenagers recently diagnosed with diabetes. All had their blood sugar normalised with metformin, and were then given one of three treatments to try to maintain that control - metformin alone, metformin plus diet and exercise counselling, or metformin plus a second drug, Avandia.

After nearly four years, half in the metformin group failed to maintain blood sugar control. The odds were a little better for the group that took two drugs but not much different for those in the lifestyle group. Even so, Dr Zeitler said doctors would not recommend this combination drug therapy because Avandia has been linked to higher risk of heart attacks in adults. Those risks became known after this study had started.

The results were published online by the New England Journal of Medicine and presented at a paediatric meeting in Boston, Massachusetts. The National Institutes of Health funded the study and drug companies donated the medications.

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