J Korean Diabetes.  2024 Mar;25(1):4-8. 10.4093/jkd.2024.25.1.4.

Management of Early-Onset Type 2 Diabetes

Affiliations
  • 1Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea

Abstract

Early-onset type 2 diabetes is experiencing a rapid global increase, coinciding with the escalating rates of obesity. In contrast to diagnoses later in life, an earlier diagnosis is associated with unexplained excess risk of microvascular complications, adverse cardiovascular outcomes, and premature mortality. Patients with early-onset type 2 diabetes appear to undergo a more aggressive clinical course, which can be exacerbated by the limited availability of treatments. The heightened burden of complications places individuals with early-onset type 2 diabetes at a substantial risk of multimorbidity, underscoring the urgency for interventions to reverse these concerning trends. While the pathophysiology and interventions for adolescent-onset (< 19 years) type 2 diabetes within the early-onset cohort have received considerable attention in research, young adults aged 19~39 years (a larger proportion numerically) remain insufficiently characterized and are notably absent in the current evidence guiding management. Current management approaches derived from trials in later-onset type 2 diabetes may not be suited for this specific demographic. This review provides a comprehensive summary of recent findings related to early-onset type 2 diabetes, aiming to contribute valuable insights that could shape future strategies for prevention, diagnosis, and treatment.

Keyword

Adolescent; Diabetes mellitus, type 2; Young adults

Reference

1.Sun H., Saeedi P., Karuranga S., Pinkepank M., Ogurtsova K., Duncan BB, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022. 183:109119.
Article
2.Bae JH., Han KD., Ko SH., Yang YS., Choi JH., Choi KM, et al. Diabetes fact sheet in Korea 2021. Diabetes Metab J. 2022. 46:417–26.
Article
3.World Health Organization (WHO). IDF diabetes atlas 2021. Geneva: WHO;2021.
4.Misra S., Ke C., Srinivasan S., Goyal A., Nyriyenda MJ., Florez JC, et al. Current insights and emerging trends in early-onset type 2 diabetes. Lancet Diabetes Endocrinol. 2023. 11:768–82.
Article
5.Bjornstad P., Drews K., Zeitler PS. Long-term complications in youth-onset type 2 diabetes. Reply. N Engl J Med. 2021. 385:2016.
6.TODAY Study Group. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012. 366:2247–56.
7.Writing Group for the SEARCH for Diabetes in Youth Study Group. Incidence of diabetes in youth in the United States. JAMA. 2007. 297:2716–24.
8.Sargeant JA., Brady EM., Zaccardi F., Tippins F., Webb DR., Aroda VR, et al. Adults with early-onset type 2 diabetes (aged 18-39 years) are severely underrepresented in diabetes clinical research trials. Diabetologia. 2020. 63:1516–20.
Article
9.Wright AK., Welsh P., Gill JMR., Kontopantelis E., Emsley R., Buchan I, et al. Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA1c and lipid levels at the diagnosis of type 2 diabetes relative to people without diabetes. Diabetologia. 2020. 63:1542–53.
Article
10.Luo J., Hodge A., Hendryx M., Byles JE. Age of obesity on-set, cumulative obesity exposure over early adulthood and risk of type 2 diabetes. Diabetologia. 2020. 63:519–27.
Article
11.Bjerregaard LG., Jensen BW., Ängquist L., Osler M., Sørensen TIA., Baker JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med. 2018. 378:1302–12.
Article
12.Shield JP., Lynn R., Wan KC., Haines L., Barrett TG. Management and 1 year outcome for UK children with type 2 diabetes. Arch Dis Child. 2009. 94:206–9.
Article
13.Perng W., Oken E., Dabelea D. Developmental overnutrition and obesity and type 2 diabetes in offspring. Diabetologia. 2019. 62:1779–88.
Article
14.Dabelea D., Mayer-Davis EJ., Lamichhane AP., D'Agostino RB Jr., Liese AD., Vehik KS, et al. Association of intrauter-ine exposure to maternal diabetes and obesity with type 2 diabetes in youth: the SEARCH Case-Control Study. Diabetes Care. 2008. 31:1422–6.
15.Shah RD., Chernausek SD., El Ghormli L., Geffner ME., Keady J., Kelsey MM, et al. Maternal diabetes in youth-on-set type 2 diabetes is associated with progressive dysgly-cemia and risk of complications. J Clin Endocrinol Metab. 2023. 108:1120–31.
Article
16.Kahn LG., Philippat C., Nakayama SF., Slama R., Trasande L. Endocrine-disrupting chemicals: implications for human health. Lancet Diabetes Endocrinol. 2020. 8:703–18.
Article
17.TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and β-cell function in TODAY. Diabetes Care. 2013. 36:1749–57.
18.Sam S., Edelstein SL., Arslanian SA., Barengolts E., Buchan-an TA., Caprio S, et al. Baseline predictors of glycemic worsening in youth and adults with impaired glucose tol-erance or recently diagnosed type 2 diabetes in the restoring insulin secretion (RISE) study. Diabetes Care. 2021. 44:1938–47.
Article
19.Donnelly LA., Zhou K., Doney ASF., Jennison C., Franks PW., Pearson ER. Rates of glycaemic deterioration in a real-world population with type 2 diabetes. Diabetologia. 2018. 61:607–15.
Article
20.Ke C., Stukel TA., Shah BR., Lau E., Ma RC., So WY, et al. Age at diagnosis, glycemic trajectories, and responses to oral glucose-lowering drugs in type 2 diabetes in Hong Kong: a population-based observational study. PLoS Med. 2020. 17:e1003316.
Article
21.Arslanian SA., El Ghormli L., Kim JY., Tjaden AH., Barengolts E., Caprio S, et al. OGTT glucose response curves, insulin sensitivity, and β-cell function in RISE: compar-ison between youth and adults at randomization and in response to interventions to preserve β-cell function. Diabetes Care. 2021. 44:817–25.
Article
22.Srinivasan S., Chen L., Todd J., Divers J., Gidding S., Chernausek S, et al. The first genome-wide association study for type 2 diabetes in youth: the progress in diabetes ge-netics in youth (ProDiGY) consortium. Diabetes. 2021. 70:996–1005.
Article
23.Wu H., Lau ESH., Ma RCW., Kong APS., Wild SH., Goggins W, et al. Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001-2016: a retrospective cohort study. Diabetologia. 2020. 63:757–66.
Article
24.Magliano DJ., Chen L., Carstensen B., Gregg EW., Pavkov ME., Salim A, et al. Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data. Lancet Diabetes Endocrinol. 2022. 10:112–9.
Article
25.TODAY Study Group. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021. 385:416–26.
26.Chan JC., Lau ES., Luk AO., Cheung KK., Kong AP., Yu LW, et al. Premature mortality and comorbidities in young-on-set diabetes: a 7-year prospective analysis. Am J Med. 2014. 127:616–24.
Article
27.Wu H., Lau ESH., Yang A., Fan B., Ma RCW., Kong APS, et al. Young age at diabetes diagnosis amplifies the effect of diabetes duration on risk of chronic kidney disease: a prospective cohort study. Diabetologia. 2021. 64:1990–2000.
Article
28.Tamborlane WV., Laffel LM., Shehadeh N., Isganaitis E., Van Name M., Ratnayake J, et al. Efficacy and safety of da-pagliflozin in children and young adults with type 2 diabetes: a prospective, multicentre, randomised, parallel group, phase 3 study. Lancet Diabetes Endocrinol. 2022. 10:341–50.
Article
29.Laffel LM., Danne T., Klingensmith GJ., Tamborlane WV., Willi S., Zeitler P, et al. Efficacy and safety of the SGLT2 inhibitor empagliflozin versus placebo and the DPP-4 inhibitor linagliptin versus placebo in young people with type 2 diabetes (DINAMO): a multicentre, randomised, double-blind, parallel group, phase 3 trial. Lancet Diabetes Endocrinol. 2023. 11:169–81.
Full Text Links
  • JKD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr