Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial

Abstract

Summary With the rise in childhood obesity, type 2 diabetes mellitus (T2DM) has been recognized to occur in adolescents with increasing frequency. Although much is known about T2DM in adults, few studies have examined the treatment and complications of T2DM in youth. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study was designed to evaluate the efficacy of various treatments and provided a unique opportunity to study the disease progression and appearance of complications in a pediatric cohort with recent onset of the disease. In the TODAY study, hypertension was present in 11.6% of the population at baseline and increased to 33.8% by the end of the study. Prevalence of high-risk LDL-cholesterol rose from 4.5% at baseline to 10.7% at the end of the study. Microalbuminuria was found in 6.3% of the cohort at baseline and increased to 16.6%. Retinopathy was not assessed upon entry into TODAY, but was present in 13.9% of the TODAY cohort at the end of the study. Experience to date indicates that these complications and comorbidities are similar to that seen in adults, but occur on an accelerated timeline. The early manifestation of diabetes complications in youth-onset T2DM suggests that this group will be burdened with the tangible consequences of cardiovascular disease, nephropathy, and retinopathy in the third and fourth decades of life. It is hoped that through an early, aggressive approach to treatment and prevention, we may be able to curb the onset and progression of these potentially devastating outcomes.

Social Determinants of Health and Racial/Ethnic Disparities in Type 2 Diabetes in Youth

“…In contrast, findings from the TODAY study did not indicate many racial/ethnic differences in T2DM comorbidities or complications among youth [22]. Overall, the higher rate of T2DM and poorer glycemic control in minority youth is particularly troublesome, given that individuals with an onset of T2DM in adolescence may experience complications during early adulthood years that are typically productive [22]. Such an increase in T2DM complications in early adulthood could amplify the significant and costly disparities among minority adults with T2DM [23–25].…”

“…Another study indicated Hispanic parents have higher burden from their children’s diabetes management [26]. No racial/ethnic differences have been found in depressive symptoms in the TODAY trial or depression screening study conducted by the pediatric diabetes consortium [22, 27•]. Finally, no racial/ethnic differences have been found in binge-eating [22].…”

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

“…The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study reported that youth with type 2 diabetes experience complications and comorbidities that are similar to those seen in adults (hypertension, high LDL-cholesterol, micoalbuminuria, and retinopathy) but on an accelerated timeline. This acceleration in complications suggests that cardiovascular disease, nephropathy, and retinopathy may be prevalent in this group during their 30's and 40's (Tryggestad & Willi, 2015). These life threatening complications and comorbidities make transitional care even more important for emerging adults with type 2 diabetes.…”

Update on Youth-Onset Type 2 Diabetes

“…Prior to the late 1990s, T2D was a rare entity in children and an increase in prevalence was first described in urban minority youth in 1996 [1, 2]. At the present time, youth-onset T2D spans across continents and affects children of all ethnicities and socioeconomic backgrounds.…”