Hormonal
Intensive glycaemic control in adolescents and young adults with Type 2 diabetes yields only modest gains in remaining life expectancy (0.98 years) and quality-adjusted life expectancy (0.44 QALYs) compared to conventional treatment, and may result in a net loss of QALYs when the disutility of intensive treatment (e.g., insulin) is accounted for.
For young people newly diagnosed with Type 2 diabetes, aggressive treatment with insulin offers very little extra life expectancy (less than 1 year) and may actually reduce overall quality of life due to the burden of treatment. A comprehensive plan focusing on cardiovascular risk factors (blood pressure, cholesterol) and lifestyle changes might be more beneficial than intensive insulin therapy alone, especially if the patient values quality of life highly.
Intensive treatment afforded an incremental 0.98 years and 0.44 discounted QALYs... Incorporating disutility (loss in health-related quality of life) of intensive treatment resulted in net loss of QALYs.
Why this rating
Based on a Markov model adapted from adult data (UKPDS) and limited youth-specific utility data, not a direct long-term RCT in youth.
Source
Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus
Erinn T. Rhodes et al. · Diabetic Medicine · 2011
DOI 10.1111/j.1464-5491.2011.03542.x
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