Spotlight on younger-onset diabetes

Several recent publications focused on younger-onset type 2 diabetes.

One study, published by The Lancet Diabetes & Endocrinology on Oct. 23, compared mortality rates and diabetes complications by whether patients were diagnosed with type 2 diabetes before or after age 40 years. It used data from the UK Prospective Diabetes Study, collected between 1977 and 2007, on 4,550 patients with type 2 diabetes, categorized as younger-onset (diagnosed before age 40 years; mean age at diagnosis, 35 years) or later-onset (diagnosed at 40 years or older; mean age at diagnosis, 54 years). All patients were tested for diabetes autoantibodies and only patients without autoantibiodies for type 1 diabetes were included. Patients were observed for a median duration of 18 years. Compared to the U.K. general population, the 429 younger-onset patients (9.4%) had a threefold increase in the standardized mortality ratio (SMR) (3.72; 95% CI, 2.98 to 4.64), much greater than that in later-onset patients (SMR, 1.54; 95% CI, 1.47 to 1.61). For all outcomes except microvascular disease, the incidence rate was higher in later-onset type 2 diabetes, but at any given age, the five-year incidence of any diabetes-related endpoint or all-cause mortality was higher in the younger-onset group. “Our findings support the need to develop interventions and services that identify and support the health-care needs of these individuals over their lifetimes,” said the study authors.

An accompanying editorial comment noted that it's uncertain whether younger-onset patients' “propensity to develop complications relates to diabetes duration or to adverse biological predisposition” but that “the message is clear: aggressive management is imperative in young adult-onset type 2 diabetes.” This should include active treatment of cardiovascular risk factors, the editorialists added, noting that the study data were collected before some of the current classes of diabetes drugs were widely available.

Another study, published as a letter by the New England Journal of Medicine on Oct. 30, assessed the long-term effects of bariatric surgery during adolescence. It looked at a cohort of 161 patients who underwent gastric bypass and 99 who got sleeve gastrectomy at a mean age of 17 years. At 10 years after surgery, patients' body mass index (BMI) had decreased by a mean of 20% (95% CI, −22.9% to −17.1%). Changes in BMI were similar with the two surgeries. In addition, 55% of the surgery patients had remission of type 2 diabetes, a rate that the study authors said “far exceeded the 18% and 12% reported among adults at 7 and 12 years, respectively, in a recent multicenter randomized, controlled trial.” The results indicate “long-term durability of weight loss and remission of coexisting conditions after bariatric surgery, as well as the greater health benefits and durability of the effects in adolescents than would be expected in similarly treated adults,” the authors concluded.

Also in October, the NIH announced a nationwide consortium to study the biologic, social, and environmental drivers of youth-onset type 2 diabetes. The observational study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases and will build on previous evidence that youth-onset type 2 diabetes is more challenging to treat and progresses more aggressively compared to adult-onset type 2 diabetes. The study aims to identify unique drivers of youth-onset type 2 diabetes by recruiting 3,600 participants, ages 9 to 14 years, who are considered at risk for type 2 diabetes, a press release said.