Survey of Current Medical Treatments for Childhood-Onset Type 2 Diabetes Mellitus in Japan

The prevalence of childhood-onset type 2 diabetes mellitus has increased dramatically over the past two or three decades in Japan, but epidemiological and clinical data remain limited. This survey was conducted to elucidate the current use of antidiabetic medications and the efficacy, safety and problems associated with the use of these agents. Clinical data on 259 children (younger than 18 yr of age; 121 boys and 138 girls) with type 2 diabetes treated at 42 medical centers throughout Japan between June and September 2003 were analyzed. Sixty-nine percent of all the type 2 diabetic patients (78% of the boys, 63% of the girls) were obese (percent overweight ≥ 20%) at the time of diagnosis. Overall, 172 subjects (66%) were treated using anti-hyperglycemic agents, including α-glucosidase inhibitors (α-GI), insulin, metformin and sulfonylureas (SUs). Many patients who were initially treated with a single medication eventually required insulin alone or in combination with an additional agent, suggesting that their diabetic control had deteriorated during the course of treatment. The HbA1c level of the 14 subjects who received only metformin decreased significantly without an improvement in obesity. Three cases with adverse events were reported, but causal relations with anti-hyperglycemic agents were not clear. In conclusion, mainly α-GI, insulin and metformin have been prescribed for childhood-onset type 2 diabetes patients in Japan. The results of this survey suggest that metformin is safe and effective for the treatment of type 2 diabetes with obesity in children and adolescents.