Long-Term Complications in Youth-Onset Type 2 Diabetes

BACKGROUND: The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood.

METHODS: We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of 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. After completion of the trial, participants were enrolled in an observational follow-up study (performed from 2011 to 2020). Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice.

RESULTS: At the end of the follow-up study, the mean age of the 500 participants was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, dyslipidemia was 51.6%, diabetic kidney disease was 54.8%, and nerve disease was 32.4%. The prevalence of retinal disease was 13.7% in 2010-2011 and 51.0% in 2017-2018. At least one complication occurred in 60.1% of participants, and at least two occurred in 28.4%. Risk factors for complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia.

CONCLUSIONS: Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia.

BACKGROUND: The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood.

METHODS: We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of 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. After completion of the trial, participants were enrolled in an observational follow-up study (performed from 2011 to 2020). Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice.

RESULTS: At the end of the follow-up study, the mean age of the 500 participants was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, dyslipidemia was 51.6%, diabetic kidney disease was 54.8%, and nerve disease was 32.4%. The prevalence of retinal disease was 13.7% in 2010-2011 and 51.0% in 2017-2018. At least one complication occurred in 60.1% of participants, and at least two occurred in 28.4%. Risk factors for complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia.

CONCLUSIONS: Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia.