Young Adult Type 2 Diabetes Increasingly Associated with Serious Complications

June 19, 2019

Diabetes complications in young adults with type 2 diabetes are occurring in unusually high rates, researchers reported at the American Diabetes Association annual meeting held earlier this month in San Francisco.

Diabetes complications in young adults with type 2 diabetes are occurring in unusually high rates, researchers reported at the American Diabetes Association annual meeting held earlier this month in San Francisco.

The study, presented by Philip S. Zeitler, M.D., Ph.D., of Children’s Hospital Colorado, showed extensive development of severe renal, cardiac, eye, nerve and pregnancy complications in less than a decade of diagnosis.

“Many of these risk factors and overt complications are not being as vigorously managed as these data suggest is needed,” Dr. Zeitler stated in a press release, noting that in particular, less than half of participants were being treated for high blood pressure or high lipid levels that were already clinically evident. “Since these individuals are battling the disease at a younger age, they are experiencing life-changing health consequences caused by type 2 diabetes at the earliest stages of adulthood,” suggesting they will require even more intense management as they age.

The study, called Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY), included 517 participants (mean age 25 years). The average time since diagnosis was 12 years. More than half had abnormal lipids, more than 60 percent had high blood pressure, and about 40 percent showed evidence for early diabetic kidney disease. Diabetic retinal disease was also evident in 50 percent of the group. Early signs of diabetic nerve disease were associated with poor glucose control in one-third of the group.

One quarter of the 306 pregnancies in the group had preterm deliveries and of 236 known outcomes, 25 percent resulted in miscarriage or fetal death.

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Dr. Zeitler observed that acceptance of the need for more aggressive therapies in young adults appears to be split.

“Those providers who work with these kids and keep up with the research are probably coming around to more aggressive treatment. The barrier is the intrinsic resistance that occurs in people taking care of youth who hesitate to add medications for kids who are so young and don’t seem like they should need more meds. The fact is that the evidence base is lacking and the choice to treat blood pressure and/or lipids aggressively has to be supported by extrapolation of adult data and some providers are, not unreasonably, hesitant to do this extrapolation and start medications that aren’t proven to be needed,” he said.

Dr. Zeitler pointed to the ADA guidelines published in December 2018 as a good place for providers to look for a reasonable approach to management of young adults with type 2 diabetes based on current knowledge. 

The National Institutes of Health has committed to start a new study to address prevention and effective interventions for youth-onset type 2 diabetes, Dr. Zeitler said.