Teenagers with type 2 diabetes often have complications in their twenties

Of the 500 teens with type 2 diabetes, two-thirds already have one diabetes complication by their twenties and one-third have at least two diabetes complications. That is what Petter Bjornstad and colleagues recently wrote in NEJM.

In a intervention study published in NEJM in 2017, nearly 700 U.S. teens with type 2 diabetes were randomized to metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention. The majority were followed for years after completion of the intervention study (2011-2020) via the observational follow-up study that recently appeared in NEJM.

From baseline to the end of the observational follow-up study, the mean BMI fluctuated between 35 and 37.5 and the number of participants with well-regulated Hb1Ac decreased to 19 percent. At the end of this observational follow-up study, the average age of the 500 participants was over 26 years. They had had an average of about 13 years of type 2 diabetes, which was almost always treated with metformin and/or insulin. The cumulative risk of a microvascular diabetes complication—hypertension, dyslipidemia, damage to kidneys, nerves, or eyes—five years after the diabetes diagnosis was 80 percent. At the last follow-up visit, 32 percent had one diabetes complication and nearly a third had at least two diabetes complications. Serious cardiovascular events did occur, but were rare – 3.73 per 1000 person-years.

The researchers conclude that complications occurring in teens with type 2 diabetes accumulate rapidly in the decade after diagnosis. According to them, this is faster than if type 2 diabetes is diagnosed in adulthood.

DOI: 10.1056/NEJMoa2100165

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