Study shows dramatic long-term complications in youth-onset type 2 diabetes

Researchers report that patients diagnosed with type 2 diabetes in their youth are, by young adulthood, at risk of serious complications.

The findings from the TODAY2 study (Treatment Options for type 2 Diabetes in Adolescents and Youth) appeared in the NEJM/New England Journal of Medicine on July 28, 2021.

“Youth-onset of type 2 diabetes is associated with an accumulation of diabetes-related complications such as eye disease, kidney disease, nerve disease and other co-morbidities like strokes, heart disease, amputations — and this is occurring at least as rapidly as in adults. Potentially more rapidly,” said Phil Zeitler, M.D., Ph.D, chair of the TODAY study group and professor of pediatrics and  endocrinology at the University of Colorado School of Medicine in Aurora, Colorado.

As background, the authors noted that the TODAY team previously conducted a multicenter clinical trial from 2004 to 2011 to compare the effects three treatments (metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention) on the time to loss of glycemic control in participants who had onset of type 2 diabetes in youth.

At the end of that trial, subjects were transitioned to metformin with or without insulin and were enrolled in a follow-up study (2011 to 2020), the newly reported TODAY2 study.

The investigators performed annual assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease. They assessed for retinal disease twice. They also confirmed other complications related to diabetes.

At the end of the second phase of the follow-up study (January 2020), the mean age of the 500 subjects was 26.4 years. The mean time since the diagnosis of diabetes was 13.3 years.

During follow-up, the cumulative incidence of hypertension was 67.5%, the incidence of dyslipidemia was 51.6%, the incidence of diabetic kidney disease was 54.8%, and the incidence of nerve disease was 32.4%.

Prevalence of retinal disease was 13.7% from 2010 to 2011 and 51.0% from 2017 to 2018.

There was at least one complication in 60.1% of the subjects. There were at least two complications in 28.4% of the subjects.

Risk factors for the development of complications included minority race or ethnic group, hyperglycemia, hypertension and dyslipidemia.

Zeitler said, “It is really critical for governments, policymakers, and healthcare systems to be prepared for what this means in terms of healthcare usage; loss of productivity years; loss of life; impact on families; unemployment; as well direct costs — a lot of money will be spent on these kids through dialysis, medications, cardiac bypass and more.”

Addressing the question of future research, Zeitler said. “The next step is to put together a new cohort of younger children to understand who gets type 2 diabetes.