Challenges and pitfalls of youth-onset type 2 diabetes

Abstract

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) are increasing. The rise in frequency and severity of childhood obesity, inclination to sedentary lifestyle, and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications. Indeed, youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM, with greater insulin resistance and more rapid deterioration of beta cell function. Therefore, intermediate complications such as microalbuminuria develop in late childhood or early adulthood, while end-stage complications develop in mid-life. Due to the lack of efficacy and safety data, several drugs available for the treatment of adults with T2DM have not been approved in youth, reducing the pharmacological treatment options. In this mini review, we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Keywords: Youth-onset type 2 diabetes mellitus; Insulin resistance; Beta cell failure; Risk factors; Therapy; Complications

Core Tip: Youth-onset type 2 diabetes mellitus (T2DM) is a growing medical challenge, affecting children and adolescents worldwide. Its clinical course is often more aggressive than in type 1 or adult-onset type 2 diabetes, with earlier development of complications. Results of lifestyle interventions have been disappointing, yet the available pharmacotherapy options for children and adolescents with T2DM are still more limited than for adult patients. The introduction of newer agents that target glycemic control, but also promote weight loss and offer cardiovascular and renal benefits, has the potential to significantly improve the health trajectory of youth with T2DM.