Type 2 Diabetes in Youth: Bad Disease, Big Challenge for Primary Care

An Expert Interview With Jencia Wong, MD, PhD

Linda Brookes, MSc; Jencia Wong, MD, PhD

Disclosures

March 21, 2014

In This Article

Type 2 Diabetes in Youth: How Serious Is It?

Over the past 30 years, type 2 diabetes (T2DM), in the past a disease predominantly seen in middle-aged and older people, has become more common in adolescents and now accounts for a significant proportion of youth-onset diabetes in certain at-risk populations. Although type 1 diabetes mellitus (T1DM) remains the most common form of diabetes (about 90%) in this age group, with an incidence estimated to be increasing by 3% annually worldwide,[1] the incidence of T2DM in young people is also increasing in many countries, attributed largely to rising levels of obesity. It has been estimated that approximately 20,000 people under 20 years of age had T2DM in 2010 in the United States,[2] a number that could quadruple by 2050.[3,4]

Young-onset T2DM is the more lethal phenotype of diabetes, associated with more unfavorable cardiovascular disease (CVD) risk factors and more and earlier complications compared with T1DM. It has the potential to become a global public health issue with serious widespread health outcomes. Because this is a relatively new problem, however, few data exist on the long-term impact of T2DM in youth. The aim of an investigation by Jencia Wong, MD, PhD, and colleagues was to determine the long-term outcomes and survival in patients treated at the Diabetes Centre of the Royal Prince Alfred Hospital in Sydney, Australia. The researchers matched records from the hospital's Diabetes Clinical Database with those of the Australian National Death Index to establish mortality outcomes for all patients from 1986 to June 2011. Clinical and mortality outcomes in 354 patients diagnosed with T2DM, aged 15-30 years, were compared with 470 patients diagnosed with T1DM at a similar age. The results showed that, over a median observation period of more than 20 years in both groups, mortality was significantly greater in the T2DM group (11% vs 6.8%, P =.03), with a significant 2-fold higher risk for death (hazard ratio, 2.0; 95% confidence interval (CI), 1.2-3.2; P = .003).[5,6] This difference persisted when only white patients from each group were compared.

Deaths in the T2DM group occurred after a significantly shorter median disease duration (26.9 vs 36.5 years, P = .01) and at a relatively young age (in the third decade of life). There were more cardiovascular deaths in the T2DM group (50% vs 30%, P < .05). CVD risk factors, such as high body mass index, albuminuria, dyslipidemia, and elevated systolic and diastolic blood pressure, a constellation called "alarming" by the researchers, were found early on in the disease (average age, 29 years), before any evidence of clinical macrovascular complications. Despite equivalent glycemic control and shorter disease duration, the prevalence of albuminuria, CVD risk factors, peripheral neuropathy, and macrovascular complications was greater in the T2DM group, seen as early as 2-5 years after diabetes onset. The findings of this study underscore the need for intensive intervention in adolescents with T2DM, the researchers concluded, and they called for efforts to be redoubled toward prevention of diabetes in youth.

Dr. Wong spoke with Linda Brookes, for Medscape, about these challenges for primary care providers and the need to identify at-risk children and adolescents. In its recent diabetes management guideline, the American Academy of Pediatrics emphasized that the rapid emergence of youth-onset T2DM poses challenges to clinicians who may be unequipped to treat adult diseases encountered in children.[7]

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