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28-07-2021 | Diabetes | News | Article

Complications ‘accumulate rapidly’ in youth-onset type 2 diabetes

Claire Barnard

medwireNews: The risk for diabetes-related complications increases over time among people with youth-onset type 2 diabetes, with the majority having at least one microvascular complication by the time of young adulthood, suggest follow-up results from the TODAY study.

“[T]hese data illustrate the serious personal and public health consequences of youth-onset type 2 diabetes in the transition to adulthood,” write the researchers in The New England Journal of Medicine.

The analysis included 500 people who participated in the TODAY trial in 2004–2011, enrolled in the TODAY2 longitudinal study, and attended annual follow-up visits while receiving standard care in 2014–2020. At the end of the study, participants were aged an average of 26.4 years and had a mean diabetes duration of 13.3 years; the average total duration of follow-up was 10.2 years.

Kimberly Drews (George Washington University, Rockville, Maryland, USA) and colleagues report that complications occurred “early” in the TODAY participants and accumulated rapidly over time, with 60.1% of participants developing at least one microvascular complication over the course of the study.

The proportion of participants with hypertension rose from 19.2% at baseline to 67.5% at the 15-year follow-up, while the proportion with dyslipidemia increased from 20.8% to 51.6%.

Similarly, 8.0% of participants had kidney disease at baseline, rising to 54.8% at 15 years, and a corresponding 1.0% and 32.4% had nerve disease at these timepoints.

In addition to these complications, the researchers found that “serious cardiovascular events, although uncommon, occurred despite the young age of the participants.” There were 17 such events in total, including four cases of myocardial infarction, six of congestive heart failure, three of coronary artery disease, and four of stroke.

The overall rate of adjudicated cardiovascular and cerebrovascular events was 3.73 per 1000 person–years, while rates of eye disease events, nerve events, and kidney events were 12.17, 2.35, and 0.44 per 1000 person–years, respectively.

Drews and team also evaluated factors associated with the development of microvascular complications, finding that non-Hispanic Black and Hispanic people had a significantly higher risk than non-Hispanic White people.

After adjustment for age, sex, diabetes duration, and race and ethnic group, hyperglycemia was significantly associated with microvascular complication risk (odds ratio [OR]=1.80 per 1% increase in glycated hemoglobin [HbA1c]), as was the presence of hypertension (OR=3.18) and dyslipidemia (OR=2.77). Median HbA1c levels increased over time in the study, and the proportion of participants with HbA1c levels below 6% (48 mmol/mol) decreased from 75% at baseline to 19% at the 15-year follow-up.

“Given the associations of hyperglycemia, hypertension, and dyslipidemia with a high risk for the development of complications, studies exploring early aggressive management of glycemia and risk factors in youth-onset type 2 diabetes are needed,” conclude the researchers.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

N Engl J Med 2021; 385: 416–426

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