ESPE Yearbook of Paediatric Endocrinology

The New England Journal of Medicine 2021;385(5):416-26. doi: 10.1056/NEJMoa2100165

Brief Summary: This multicenter observational study assessed the cumulative incidence of diabetic complications in 500 adolescents with Type 2 diabetes (T2DM), followed from 2011 to 2020. After only 13 years from T2DM diagnosis, higher complication rates were observed than those reported for pediatric patients with T1DM or for adults with T2DM.

Comment: This is the second phase of the TODAY study. After completing the first phase, 500 adolescents were transitioned to metformin with or without insulin and were enrolled in an observational follow-up study for over one decade. The first striking finding is the poor glycemic control of the participants. Whereas glycemic control in adolescents with T1DM tends to improve with age, a gradual deterioration occurred in adolescents with T2DM throughout the follow-up; about 45.0% had HbA1c of at least 10% and about 20% had HbA1c of 8–10%. Their median BMI remained 35.0 to 37.5 kg/m^2.

Poor glycemic control and obesity were associated with early complications. Thirteen years (on average) after initial diagnoses of T2DM, incidence rates for hypertension, dyslipidemia, diabetic kidney disease and neuropathy were 67.5%, 51.6%, 54.8% and 32.4%, respectively, and retinopathy was present in 51%. One-fifth (21.3%) had two complications, and 7.1% had three. Seventeen serious cardiovascular events occurred (four myocardial infarctions, six congestive heart failures, three cases of coronary artery disease and four stroke events). Six deaths were reported. This rapid development of complications was associated with severe insulin resistance and poor socioeconomic circumstances. Hopefully, with the arsenal of new medications for adolescents with T2DM,^1,2.3 we will see a different picture over the next decade.

References: 1. ESPE Yearbook of Paediatric Endocrinology (2020) 17 12.5 | DOI: 10.1530/ey.17.12.5. 2. Arslanian SA, Hannon T, Zeitler P, Chao LC, Boucher-Berry C, Barrientos-Pérez M, Bismuth E, Dib S, Cho JI, Cox D; AWARD-PEDS Investigators. Once-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes. N Engl J Med. 2022 Jun DOI:. Epub ahead of print. PMID: 35658022. 3. Tamborlane WV, Bishai R, Geller D, Shehadeh N, Al-Abdulrazzaq D, Vazquez EM, Karoly E, Troja T, Doehring O, Carter D, Monyak J, Sjöström CD. Once-Weekly Exenatide in Youth With Type 2 Diabetes. Diabetes Care. 2022 Jun 9:dc212275. DOI:. Epub ahead of print. PMID: 35679098.