“Shocking” early complications of teenage type 2 diabetes

July 30, 2021-Newly published data show a surprisingly high rate and severity of early diabetes-specific complications in affected individuals Type 2 diabetes Be young. This suggests that the intervention should be early and aggressive among these young people, one of the researchers said.

The results of 500 young adult participants in the Adolescents and Adolescents Treatment Options for Type 2 Diabetes (Today 2) study are as follows: Published online July 28 New England Journal of Medicine By today’s research group.

In follow-up, their average age was 26.4 years after they first participated in the TODAY trial when they were young teens.

At this point, more than two-thirds had hypertension and half had dyslipidemia or high levels of dyslipidemia. cholesterol Or fat in the blood.

Overall, 60% had at least one diabetic microvascular complication (retinopathy, neuropathy, or diabetic nephropathy), and more than a quarter had two or more such complications.

“These data show the serious impact of the onset of adolescents on individuals and public health. Type 2 diabetes During the transition to adulthood. “

Don’t step lightly just because you’re a child

“The fact that these young people are rapidly accumulating complications and are widely affected early in adulthood suggests that they are certainly aggressive. Treatment It is needed for both glycemic control and the treatment of risk factors such as hypertension and dyslipidemia, “said Dr. Philip S. Zeitler, co-author of the study.

“Without a study that specifically addresses this, given that the age at diagnosis is as young as about 14, we need to take a more aggressive approach than people would like,” he says.

“Contrary to the tendency to be’gentle’to treat them because they are children, these data cannot pass these first years without strong intervention and are polypharmacy. Suggests that preparation is needed. “

Unfortunately, as explained by Zeitler and his co-authors, the onset of adolescents Type 2 diabetes It is characterized by a non-optimal response to currently approved medical treatments for diabetes.

New US pediatric indications for drugs used to treat adult type 2 diabetes, including the recent Food and Drug Administration Approval Zeitler of Aurora’s Colorado Children’s Hospital Clinical and Translational Research Center states that the effects of sustained release exenatide for children up to the age of 10 are “helpful, but negligible.”

“In some cases, it helps to cover with a carrier. This is always a good thing. But this is still a very limited set of drugs. The recently approved and more potent glucagon-like peptide-1 (GLP-). 1) is not included.) It is an agonist like semaglutide and does not contain a sodium-glucose cotransporter 2 (SGLT2) inhibitor. Pediatricians are accustomed to using unlabeled drugs. , Needed here while waiting for further approval, “he says.

In the United States, most young people with type 2 diabetes are covered or uninsured, depending on the state in which they live, he says. Two majors Medicaid The Colorado program allows full access to adult prescription books, but not everywhere. In addition, in states where Medicaid has not been expanded, patients often face additional access barriers.

Follow-up shows all metrics that get worse over time

In TODAY 2, patients participated in observational follow-up in a normal care environment from 2011 to 2020.Initially, they were given metformin with or without metformin Insulin In the case of diabetes, whether this continued and whether it was treated with other risk factors depended on the individual situation.

Median A1c of participants increased over time, and the proportion of A1c <6% (48 mmol / mol) decreased from 75% at today's entry to only 19% at the end of the 15-year follow-up. did.

The percentage of A1c above 10% (86 mmol / mol) increased from 0% at baseline to 34% in 15 years.

At that time, nearly 50% were taking both metformin and insulin, while more than a quarter were not taking the drug.

The prevalence of hypertension increased from baseline 19.2% to 67.5% in 2015, and dyslipidemia increased from 20.8% to 51.6%.

Kidney disease Prevalence increased from baseline 8.0% to 54.8% in 15 years. Neurological disorders rose from only 1.0% to 32.4%. Retinopathy surged from 13.7% of mild nonproliferative retinopathy in 2010-2011 to 51.0% of eye disease in 2017-2018. This includes 8.8% of moderate to severe retinal changes and 3.5% of macular edema.

Overall, on my last visit, 39.9% had no diabetic complications, 31.8% had one, 21.3% had two, and 7.1% had three complications.

A serious cardiovascular event in the mid-20s

There were 17 ruling serious cardiovascular events, including 4 myocardial infarctions and 6 Congestive heart failure Events, 3 diagnoses of coronary artery disease, and 4 strokes.

Six participants have died. One had a myocardial infarction. liver Failure, and drug overdose, and from three Sepsis..

Zeitler said macrovascular events are “shocking” and, although few, “must be zero” for people in their mid-twenties … the rates are still the same or faster. I don’t know, adults, even if they are the same, are only in their late 20s, in contrast to adults who experience these problems in their 50s, 60s, and 70s. ”

“The fact that these complications are happening when these individuals should be at the height of their lives for both family and work is significant,” he says.

There are multiple causes for the findings

He says the reasons for the findings are both biological and socio-economic.

“We already know that many children with type 2 diabetes develop rapidly. [deterioration of] Beta cells [function], This is probably very biological.Individual can Adolescents probably have diabetes because they have more fragile beta cells in some way.

“But we also know that many other things have contributed. [such as] Stress, social determinants, access to quality care and medication, access to healthy food and physical activity, availability of family supervision considering family financial status and work reality, etc. “

Adolescents with type 2 diabetes have much more severe insulin resistance than adults in that condition, and “when the children leave … [TODAY] Studies show that risk factor treatment in the community is not ideal, and many children who meet blood pressure treatment criteria Lipid It wasn’t treated. This is at least partly sociological and may partly hesitate to use common pediatric drugs. “

He states that the TODAY team will soon get some new data showing that “early blood glucose levels make a difference and support intensive intervention at an early stage.”