Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia1. The global prevalence of the condition in adults is about 8% (more than 90% of whom have type 2 diabetes), which is projected to increase to more than 10% by 20402. In recent years, studies have shown an increasing number of children, adolescents and young adults being diagnosed with type 2 diabetes. Currently, the age of onset before 20 years is defined as youth-onset type 2 diabetes. Prevalence estimates suggest a 31% increase in type 2 diabetes among people aged 10–19 years in the USA between 2001 and 2009, accounting for a prevalence of 0·48 per 1000 in this age group in 20093.
So far, multiple studies conducted in the US and Asia (India, Korea, and Japan) have looked into major diabetes-related complications for youth-onset patients. Yen et al. summarised the presentation of comorbidities and complications in patients with youth-onset type 2 diabetes in the table4 below:
Despite the fact that the definition and methodology of comorbidities and complications are defined slightly differently in each of the studies involved, all showed a relatively high incidence of major complications in those patient groups. Interestingly, the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study group also showed that minority races in the west, hyperglycaemia, hypertension, and dyslipidaemia are also risk factors for complications5. The Asian studies in the meantime indicated that suboptimal control of hyperglycaemia, hypertension and dyslipidaemia are also major contributors to diabetic complications6.
Unfortunately, not many medications are available to treat youth-onset type 2 diabetes to provide the best glycaemic control and organ protection4. Some doctors and parents are also unwilling to put children on regular heart medications for the rest of their lives. Side effects from those medications are also concerning for many.
In terms of management for youth-onset type 2 of the condition, lifestyle interventions are universally recognized as first-line therapy7. However, hyperglycaemia is rarely sufficiently controlled by diet and exercise in youth-onset type 2 diabetes, pharmacological interventions are typically required. Unfortunately, most clinical trials on the condition medications exclude youth-onset type 2 diabetes. In addition, several drugs that are available for adults with the condition are not approved for the treatment of youth-onset type8. Currently, metformin, GLP1 receptor agonist, and insulin have been approved for treating this condition. However, commonly used medications in adults such as thiazolidinedione, sulfonylurea, and SGLT2 inhibitors have not been approved despite some of the positive clinical evidence8. Another major challenge faced by doctors is that teens tend to get lost during the life-long follow-up checks for the condition, which further increases the difficulty of maintaining a good glycaemic control8.
In summary, youth-onset type 2 diabetes shares many similarities when comparing western countries to Asia. More research is needed to investigate the high treatment failure rates in youth-onset type 2 diabetes, and further explore the limited pharmaceutical options available. Yen and Hwu4 also pointed out that Asian studies could potentially focus on women and maternal condition and encourage healthy lifestyle behaviours to reduce the risk of future youth-onset type 2 diabetes in children.
References
- Goyal R, Jialal I. Diabetes Mellitus Type 2 [Internet]. NCBI. StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513253/
- IDF Diabetes Atlas 9th edition 2019 [Internet]. diabetesatlas.org. Available from: http://www.diabetesatlas.org
- Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA [Internet]. 2014 [cited 2019 Mar 7];311(17):1778–86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368900/
- Yen F, Hwu C. Similarities and differences in the natural history of youth‐onset type 2 diabetes between the West and Asia. Journal of Diabetes Investigation. 2022 Feb 18;
- Bjornstad P, Drews K, Caprio S, Gubitosi-Klug R, Nathan D, Tesfaldet B, et al. Long-term complications in youth-onset type 2 diabetes. Yearbook of Paediatric Endocrinology. 2022 Sep 12;
- Nanditha A, Ma RCW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, et al. Diabetes in Asia and the Pacific: Implications for the Global Epidemic. Diabetes Care [Internet]. 2016 Feb 23 [cited 2019 Sep 5];39(3):472–85. Available from: https://care.diabetesjournals.org/content/39/3/472
- Nadeau KJ, Anderson BJ, Berg EG, Chiang JL, Chou H, Copeland KC, et al. Youth-Onset Type 2 Diabetes Consensus Report: Current Status, Challenges, and Priorities. Diabetes Care [Internet]. 2016 Aug 2 [cited 2019 Nov 6];39(9):1635–42. Available from: https://care.diabetesjournals.org/content/diacare/39/9/1635.full.pdf
- Bjornstad P, Chao LC, Cree-Green M, Dart AB, King M, Looker HC, et al. Youth-onset type 2 diabetes mellitus: an urgent challenge. Nature Reviews Nephrology. 2022 Oct 31;
