In patients with young-onset type 2 diabetes (T2DM), the risk of complications increases steadily over time and affects most of this population in adulthood, according to a study conducted in the New England Journal of Medicine.
The researchers initially enrolled 572 patients from the Treatment Options for Type 2 Diabetes in Children, Adolescents and Youth (TODAY) trial into the TODAY2 follow-up study. In the first phase, from March 2011 to February 2014, participants were treated with metformin with or without insulin to maintain glycemic control. From March 2014 to January 2020, 500 participants were included in the phase 2 analysis. They had a median age of 26.4 ± 2.8 years (65.4% female) and a mean time of 13.3 ± 1.8 years since their diagnosis of diabetes.
The cohort had a hypertension prevalence of 19.2% at baseline, and the cumulative incidence was 67.5% at 15 years. Dyslipidemia was present in 20.8% of participants at baseline, and the cumulative incidence at 15 years was 51.6%. The prevalence of kidney disease was 8.0% at baseline, and the cumulative incidence was 54.8% at 15 years. About 1.0% of the cohort had nerve disease at baseline, and the cumulative incidence was 32.4% at 15 years.
Retinal disease was assessed twice during the study. When first assessed for retinal disease in 2010 or 2011, 13.7% of patients had very mild nonproliferative diabetic retinopathy. After 7 years (in 2017 or 2018) 51% had eye disease, including 8.8% with moderate to severe retinal changes and 3.5% with macular edema.
The cumulative incidence of any microvascular complication was 50% at 9 years after a diagnosis of T2DM and 80.1% at 15 years. Race or ethnic minority group, high glycated hemoglobin, low insulin sensitivity, hypertension, and dyslipidemia were associated with an increased risk of developing microvascular complications.
Overall, the data indicated that diabetes-related complications appear early in type 2 diabetes in young people, with at least one microvascular complication developing in over 60% of study participants. Another 28.4% had 2 or more complications of diabetes after an average age of 26.4 years, approximately 13.3 years after being diagnosed with T2DM.
The study authors noted that incomplete follow-up in about a quarter of the original cohort may have led to an under-representation of the number and accumulation of clusters of events. In addition, due to a lack of longitudinal data on microvascular complications in adolescents without diabetes but with a comparable degree of obesity, the researchers could not compare the same complications in young people without type 2 diabetes. However, the researchers have noted that it is widely recognized that the complications more specific to diabetes, such as eye disease, do not occur in populations without diabetes.
“These data show a high burden of diabetes-specific complications in type 2 diabetes in young people, with an early and severe effect on people with this disease, as well as substantial public health implications,” said the researchers.
Disclosure: One of the study’s authors declared affiliations with pharmaceutical companies. Some pharmaceutical companies donated drugs and supplies. Please see the original reference for a full list of disclosures.
Study Group TODAY; Bjornstad P, Drews KL, Caprio S, et al, and the TODAY study group. Long-term complications of type 2 diabetes in young people. N Engl J Med. 2021; 385 (5): 416-426. doi: 10.1056 / NEJMoa2100165