• 1.

    TODAY Study Group, et al. Long-term complications in youth-onset type 2 diabetes. N Engl J Med 2021; 385:416426. doi: 10.1056/NEJMoa2100165

High Complication Rates in Youth with Type 2 Diabetes

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Sixty percent of patients with youth-onset type 2 diabetes experience diabetic complications by the time they reach young adulthood, according to long-term follow-up data published in The New England Journal of Medicine (1).

In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, patients with youth-onset type 2 diabetes were assigned to metformin alone, metformin plus rosiglitazone, or metformin plus intensive lifestyle intervention. Patients were then transitioned to metformin alone or metformin plus insulin. The current analysis presents observational follow-up data from 2011 to 2020 in 500 patients.

About 65% of participants were female; 73% were Hispanic or non-Hispanic Black. At follow-up, mean age was 26.4 years and mean time since diabetes diagnosis was 13.3 years. Participants had annual follow-ups for diabetic complications, including annual assessment of diabetic kidney disease, hypertension, dyslipidemia, and nerve disease, plus two assessments for retinal disease.

During follow-up, at least one diabetic complication occurred in 60.1% of patients and at least two complications in 28.4%. Cumulative incidence was 67.5% for hypertension, 54.8% for diabetic kidney disease, 51.6% for dyslipidemia, and 32.4% for nerve disease. Prevalence of retinal disease increased from 13.7% in the follow-up period 2010–2011 to 51.0% in 2017–2018.

Rates of adjudicated, clinically identified complications were 3.73 per 1000 person-years for heart, vascular, and cerebrovascular events; 12.17 per 1000 person-years for all eye disease events; 6.70 per 1000 person-years for liver, pancreas, or gallbladder events; 2.35 per 1000 person-years for nerve events; and 0.44 per 1000 person-years for kidney events, including end-stage kidney disease.

Risk for developing any microvascular complication was about 50% higher for Hispanic and non-Hispanic Black participants, compared to non-Hispanic White patients. In adjusted models, significant risk factors included glycated hemoglobin level, body mass index, insulin sensitivity, hypertension, and dyslipidemia.

As the prevalence of youth-onset type 2 diabetes continues to rise, there is little information about the associated risk of diabetic complications. These longitudinal data show a high risk of complications that increases with age, such that a majority of patients are affected by their mid-20s.

Patients of minority race/ethnicity are at higher risk of complications. The researchers call for studies exploring early aggressive management of glycemia and risk factors in youth-onset type 2 diabetes.

[The] risk of complications… increases with age, such that a majority of patients are affected by their mid-20s.

Reference

1.

TODAY Study Group, et al. Long-term complications in youth-onset type 2 diabetes. N Engl J Med 2021; 385:416426. doi: 10.1056/NEJMoa2100165

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