Type 2 diabetes in young people leads to serious complications in early adulthood


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Adolescents with type 2 diabetes, especially those from underserved communities, are at high risk of developing serious complications in early adulthood, new research shows.

Type 2 diabetes was once considered a metabolic disorder exclusively in adulthood. Now, however, with about a third of young people in America being overweight, it has become more and more common among teenagers over the past two decades. According to the Centers for Disease Control and Prevention, between 2002 and 2015, nearly 4,000 teens between the ages of 10 and 19 were newly diagnosed with the disease.

To better understand the pathophysiology and treatment of type 2 diabetes in young people, the National Institute of Diabetes and Digestive and Kidney Diseases launched the TODAY study in 2004. It showed that type 2 diabetes in young people is extremely difficult to manage. Led by Sonia Caprio, MD, professor of pediatrics (endocrinology), Yale was among 15 centers in the United States participating in the study. To conduct this randomized clinical trial, nearly 700 children aged 10 to 17 were recruited to better understand how to treat the disease. The trial, titled Treatment Options for Type 2 Diabetes in Adolescents in Young People (TODAY), ended in 2012 and found that only half of the participants were able to manage their condition and maintain control. sustainable glycemic. Now, the team is discovering further worrying results as they follow adolescents into adulthood. In an observational follow-up study, TODAY2, the team continued to study participants from 2011 to 2020, to see if they developed any complications from the disease.

“This is the first group that received this detailed set of analyzes,” says Caprio.

TODAY2 follows 518 of the original study participants who are now in their young adulthood. As TODAY, 15 centers across the country have collaborated, including Yale, under the general direction of scientists from George Washington University. The researchers called them every year to be tested for microvascular and macrovascular complications, including diabetic kidney disease, hypertension, dyslipidemia (a metabolic disorder), nerve disease, and retinal disease. Annual testing included obtaining participants’ fasting lipid profiles, measuring blood pressure, taking urine samples, and assessing nerve conduction levels. They checked for diabetic eye disease twice during the observation period.

The results were sobering: 60% of participants had one complication and almost 30% had two complications. Sixty-seven percent had hypertension, 55% had kidney disease, 51% had dyslipidemia, 32% had nerve complications, and 51% had retinal damage. At the end of the study, the average age of the participants was only 26 years and the average time since their diagnosis was approximately 13 years. The research team published their findings in the New England Journal of Medicine.

“The gravity of the situation is that they’re very young,” Caprio says. “If they continue to live like this, their quality of life is going to be extremely poor because it is very difficult to treat these complications.”

Complications will have serious and permanent consequences. Caprio says many of those participants will need dialysis, while others will be blind. Their ability to work can be compromised and the cost of keeping them alive can triple. “This disease demands a huge effort on our part, as well as on patients and their families,” she says.

Caprio says the results show the complications are more serious than in type 1 diabetes, where they start much longer after initial diagnosis and aren’t as prevalent. Experts currently do not know why complications from type 2 diabetes in young people are so much more common and widespread. “There are a number of gaps in scientific knowledge that remain to be investigated,” says Caprio.

The presence of complications was also much more prominent among participants from underserved communities, highlighting the presence of societal issues, including poverty and lack of access to appropriate treatment, which disproportionately burden minority groups.

In the future, Caprio hopes to develop and find better drugs to treat the disease. Many drugs prescribed for adults, for example, are not approved by the FDA for children and adolescents. She also hopes to better understand the role of the liver in the development of insulin resistance in children. Many young people with type 2 diabetes also suffer from fatty liver disease, and she hopes that treatment for this disease can prevent or delay the onset of diabetes.

Caprio hopes to spread the message to the world that treating type 2 diabetes in young people is an urgent problem, because of how devastating it can be for those it affects both physically and mentally. “We need to act quickly now,” Caprio urges researchers as she watches young patients struggle with growing obstacles as they age. “It is a serious problem.”

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