Twenty years ago, the scientific study of teenagers and young adults with type 2 diabetes barely existed. Not anymore. Today doctors report patients in their 20s who have dealt with amputations, kidney failure, heart attacks, and stroke — all linked to type 2 diabetes.
A study just published in The New England Journal of Medicine represents one of the first major surveys of long-term complications of youth-onset type 2 diabetes. The investigative team, led by Phil Zeitler, MD, of the University of Colorado School of Medicine, reviewed data on over 500 people with diabetes from across the United States. The information came from what is known as the TODAY2 study (Treatment Options for Type 2 Diabetes in Adolescents and Youth). The first segment of the project was carried out from 2004 to 2011, and the second from 2011 to 2020. By the study’s end, the average age of the participants was around 27 and they had had diabetes for about 13 years.
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Higher number, more frequent complications in youth-onset type 2
The results were unsettling, to say the least. As Dr. Zeitler put it, “This is not grandma’s type 2 diabetes.” What makes youth-onset different from grandma’s is the number and frequency of complications. To begin with, the researchers described a steady decline in blood sugar control over 15 years. Unsurprisingly, this falloff was associated with reports of a high incidence of complications. In all, 80% of the patients had at least one complication and the greater part had two, three, or more — what the researchers called a “clustering of complications.” For example, two out of three of the patients (67%) had high blood pressure. More than half (55%) had kidney disease, and about the same number (52%) reported having high levels of fat — such as cholesterol and triglycerides — in the blood, a condition known as dyslipidemia. Fifty-one percent had eye disease, and about a third (32%) showed evidence of nerve damage. Also, some patients were more likely than others to develop complications — those who belonged to a minority racial or ethnic group and those who had high blood sugar, high blood pressure, and dyslipidemia. These statistics were consistent in both phases of the study.
The TODAY2 investigation was initiated not to look for complications but to investigate the best treatment options for young people. Three options were weighed: metformin alone, metformin along with rosiglitazone, and metformin along with a lifestyle intervention. The study found that treatment with metformin alone was disappointing — only half of the youth achieved satisfactory control of their blood sugar. Adding another drug, however, produced better results. And lifestyle interventions? Most young people, the researchers determined, just found it too hard to make lifestyle changes — many because their lives at home were difficult.
Dr. Zeitler summed up the findings by saying, “Youth-onset diabetes is associated with an accumulation of diabetes-related complications such as eye disease, kidney disease, nerve disease, and other comorbidities like strokes, heart disease, amputations — and this is occurring at least as rapidly as in adults. Potentially more rapidly.” He said that when the study began, youth-onset type 2 diabetes tended to be overlooked although, he said, “even at that time it was recognized that it seemed to be more aggressive in kids.”
Achieving blood sugar control in young people is important, he pointed out, because they are going to have to live with diabetes for much longer than people who develop the disease later in life. In addition, there are weighty implications for health care in general and for social and financial burdens. “It is really critical,” Dr. Zeitler said, “for governments, policymakers, and health care systems to be prepared for what this means in terms of health care usage, loss of productivity years, loss of life, impact on families, unemployment, as well as direct costs — a lot of money will be spent on these kids through dialysis, medications, cardiac bypass, and more.”