Persons with type 2 diabetes diagnosed during youth are at a high risk of developing complications at a young age, according to results of the newly published TODAY2 study. This risk increased progressively over time with multiple complications developing within 15 years after diagnosis.

TODAY2 is a follow-up of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, which began in 2004 and ended in 2011. It has been funded largely by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). The TODAY2 trial was conducted from 2011 to 2020.

The TODAY2 study included 500 original participants from the TODAY study with mean age 26 years. They were monitored annually for complications, including microvascular complications and other health events. Patients were evaluated once during the study for diabetic eye disease.

The findings published July 29, 2019 in the New England Journal of Medicine show that overall, a steady decline in glycemic control was observed over 15 years of diagnosis. It was found that 67.5% of participants had hypertension. 51.6% had dyslipidemia, 54.8% had diabetic kidney disease and 32.4% had evidence of nerve disease. The prevalence of diabetic retinopathy increased from 13.7% (from 2010-2011) to 51.0% (from 2017-2018).

60.1% of the participants had at least one diabetes-related complication, while 28.4% developed at least two or more complications. Those who belonged to a minority racial or ethnic group, or who had hyperglycemia, hypertension and dyslipidemia were at higher risk for developing a complication.

The TODAY trial was the first major comparative effectiveness trial for the treatment of type 2 diabetes in young people. It compared three treatments: metformin alone, metformin + rosiglitazone and metformin + intensive lifestyle intervention. The combination of metformin and rosiglitazone was more effective in treating youth with recent-onset type 2 diabetes than metformin alone. At the time of enrollment, participants were between the ages of 10-17, had been diagnosed with type 2 diabetes for less than two years and were overweight or obese.

Compared to adults, youth-onset type 2 diabetes is a more aggressive disease with a faster decline of β-cell function and poorer response to anti-hyperglycemic drugs; hence, it is more difficult to control. They are also more insulin resistant with early development of diabetes-related complications. The complications are amplified in the obese youth (Diabetes Care. 2018 Dec;41(12):2648-2668).

The longer a person has type 2 diabetes, the greater the chances of developing complications. This refocuses the need, especially for India, to treat type2 diabetes more aggressively in the first decade of the disease.

The prevalence of youth-onset type 2 diabetes is increasing. Hence, more and more young people are at risk of developing diabetes-related complications, such as strokes, kidney failure, heart attacks, retinopathy, which can be devastating in the most productive years of their lives. In the TODAY2 trial, many participants had at least one complication, while some had more than two complications, which is a cause for concern.

These results highlight the need for early and intensive treatment of the youth with type 2 diabetes right from the time of diagnosis to prevent or delay complications. Preventive measures should target the at-risk, especially those who are overweight or obese.

(Source: Bjornstad P, et al; TODAY Study Group. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021 Jul 29;385(5):416-426).