TODAY2: Youth-onset T2D more aggressive than adult-onset disease
Patients with youth-onset type 2 diabetes (T2D) are more likely to have an increased rate of cardiovascular (CV), kidney, eye, nerve, and pregnancy complications as they transition to early adulthood, according to the longest-running TODAY*2 study presented at ADA 2019.
“The burden of complications is accelerated as these individuals transition to young adulthood … These are kids in their mid-20s and they’re having problems you would expect from your grandparents,” said study author Dr Philip Zeitler from the University of Colorado at Anschutz Medical Campus in Colorado, Denver, US.
The original TODAY study of youth-onset T2D (n=699 patients) ran from 2004 to 2011. [N Engl J Med 2012;366:2247-2256] TODAY2 was a follow-up of 517 patients who continued on treatment. An observation-only follow-up will continue through January 2020.
The 12-year cumulative incidence of low-density lipoprotein dyslipidaemia was 26 percent and 60 percent for hypertension. Event rate for all adjudicated heart, vascular, and cerebrovascular events was 6.41 per 1,000 patient years, triple than that seen in the Diabetes Control and Complications Trial of older patients with diabetes.
Diabetic kidney disease outcomes were similarly accelerated. Half of the patients had diabetic kidney disease markers, 40 percent had microalbuminuria, and 11 percent had macroalbuminuria with A1C levels of 8 percent and higher. In addition, nearly 50 percent had evidence of diabetic retinopathy and 33 percent had early signs of nerve disease.
Of 236 pregnancies, 12 percent had a miscarriage, 3.8 percent ended in stillbirths. Of the live births, 23.7 percent were preterm.
“These individuals are battling the disease at a younger age, they are experiencing life-changing health consequences caused by T2D at the earliest stage of adulthood … Many of the risk factors and overt complications are not being as vigorously managed,” said Zeitler. “Healthcare professionals need to … aggressively treat young patients battling youth-onset T2D to minimize the damage from serious diabetes-related complications.”
*TODAY: Treatment Options for type 2 Diabetes in Adolescents and Youth