American Diabetes Association
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Effect of Early Glycemic Control in Youth-Onset Type 2 Diabetes on Longer-Term Glycemic Control and β-Cell Function: Results from the TODAY Study

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posted on 2023-06-28, 15:26 authored by Kristen J Nadeau, Laure El ghormli, Silva Arslanian, Fida Bacha, Sonia Caprio, Christine Chan, Lily C Chao, Elvira Isganaitis, Maria Rayas, Maggie K Siska, Philip Zeitler, the TODAY Study Group


Objective: Little is known about the impact of early attainment of tight glycemic control on long-term β-cell function and glycemic control in youth-onset type 2 diabetes. We examined the effect of the initial 6 months of glycemic control on β-cell function and glycemic control longitudinally over 9 years, and the impact of sex, race/ethnicity, and BMI on these relationships in adolescents with youth-onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

Research Design and Methods: Oral glucose tolerance tests were performed longitudinally through year 9 to derive estimates of insulin sensitivity and secretion. Early glycemia was defined as mean HbA1c during the first 6 months post-randomization, categorized into 5 HbA1c groups (<5.7%, 5.7-<6.4%, 6.4-<7.0%, 7.0-<8.0%, and ≥8.0%). The long-term period was defined as the period between years 2-9. 

Results: 656 participants (64.8% female, baseline mean age 14 years, diabetes duration <2 years) had longitudinal data available over an average of 6.4±3.2 years of follow-up. HbA1c significantly increased in all early glycemic groups during years 2-9, with a steeper increase (+0.40%/year) among participants with the tightest initial control (mean early HbA1c<5.7%), in parallel to a decline in the C-peptide derived disposition index. Nevertheless, the lower HbA1c categories continued to have relatively lower HbA1c over time. 

Conclusions: Early tight glycemic control in TODAY was related to β-cell reserve, and translated to better long-term glycemic control. However, tight early glycemic control on the randomized treatment in TODAY did not prevent deterioration of β-cell function. 


This work was completed with funding from NIDDK and the NIH Office of the Director through grants U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The NIDDK project office was involved in all aspects of the study, including: design and conduct; collection, management, analysis, and interpretation of the data; review and approval of the manuscript; and decision to submit the manuscript for publication.