While pediatric gastroenterologists typically are not coordinating the management pediatric patients with Type 2 Diabetes Mellitus (T2DM), we certainly see many with T2DM and often are involved in some aspects of their care (eg. fatty liver disease).
A recent study (TODAY study group. NEJM 2021; 385: 416-426. Long-Term Complications in Youth-Onset Type 2 Diabetes) details the heavy burden due to T2DM.
This “TODAY2” study annually followed 500 participants from the TODAY trial (2011). The age of the participants was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years.
- Hypertension: At 95% or greater for age (at least SBP 130 or DBP 80) on 3 consecutive visits and/or needing medical therapy
- Dyslipidemia: Consecutive LDL values of at least 130, consecutive triglycerides of at least 150, or values requiring medical therapy
- Albuminuria: ratio of urine albumin to creatinine of at least 30
- Diabetic Nerve Disease: based on scores of Michigan Neuropathy Screening Instrument -consecutive values of at least 2 or more (scores range from 0 to 8)
- Diabetic Eye Disease: based on a grade of at least 20 according to criteria of Early Treatment Diabetic Retinopathy Study criteria (grades range from 10 to 85)
- The cumulative incidence of hypertension: 67.5%
- The incidence of dyslipidemia: 51.6%
- The incidence of diabetic kidney disease:54.8%
- The incidence of nerve disease: 32.4%.
- The prevalence of retinal disease: 13.7% (2010 to 2011) and 51.0% (2017 to 2018)
The authors note that the high incidence of complications is “most likely related to extreme metabolic phenotype (which includes severe insulin resistance and rapid worsening of beta-cell function) and to challenging socioeconomic circumstances.”
Study strengths: 15 years of prospective, extensive data and population representative of U.S.
My take: “Taken together, these data illustrate the serious personal and public health consequences of youth-onset” T2DM by age 26 years!! Unless medical therapies improve further, these consequences argue for careful consideration of bariatric surgery.
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- Aspen Webinar 2021 Part 2 -Nonalcoholic Steatohepatitis
- Best Practice for Fatty Liver Disease | gutsandgrowth
- The Paramount Health Challenge for Humans in the 21st Century
- How Often Do Children with Obesity Have a Fatty Liver?
- Bariatric Surgery and Reversal of NASH in Children
- Adolescent Bariatric Outcomes
- FDA Approval of Semiglutide
- Are We On the Verge of Pharmacologic Treatment of Obesity (Again)?
- Semaglutide: Potential or Problematic New Treatment for Fatty Liver Disease/NASH
- Should We Be Excited About a New Medication (Liraglutide) for Obesity?