Younger-onset adult type 2 diabetes defined as occurring between the ages of 18-39, is rapidly increasing in prevalence as obesity increases.1 This societal change presents a challenge to physicians and the health-care system. There has not yet been enough research into this particular problem to properly inform clinicians about best practices. In the United Kingdom, the fastest rate of increase in the diagnosis of new type 2 diabetes cases is in people younger than 40 years old 2 and should be seen as a looming crisis. A better understanding of its natural history, and the risk of complications over predictable timelines, can help to inform us about the need for clinical interventions and the path to follow to direct future research.
Providing some insight into this problem is the report published in the medical journal The Lancet Diabetes & Endocrinology which lays out an analysis from the UK Prospective Diabetes Study of glucose-lowering therapies in adults with newly diagnosed type 2 diabetes.3 This review, compares the expected trajectory of illness seen as a result of the progressive development of diabetes complications, between those diagnosed as “early onset” compared to those diagnosed at a later age.
The mortality risk of younger-onset type 2 diabetes, with a mean age of diagnosis at 35 years, was shown to be significantly greater than for those with older onset diagnoses at a mean age of 54 years in this study. The data whose analysis revealed this result was obtained over a follow up period which averaged 18 years. The younger onset diabetics were shown to have poorer blood glucose control, greater insulin resistance, and a more rapid decline in their ability to secrete insulin.
The younger onset diabetics also had a higher 5-year incidence of diabetes-related complications as well as mortality when measured at any point along the 18 year follow up period. They seemed to also determine that there is a genetic component at play, as they uncovered certain more aggressive disease related biological phenotypes which were prevalent in the younger age group compared to older age group.4 Specifically the data reveals more prominent retinal and renal complications, again associated with the more aggressive phenotype of the subjects. It is still unclear how much the elevated propensity to develop complications is due to biological predisposition and how much this can be affected by avoided by effective clinical intereventions.6
Each different type of complication may have different characteristics regarding the degree to which genetic components are involved. Regardless of the exact nature of the interplay between genetic predisposition and other factors involved, it seems clear that aggressive management is of great importance in young adult-onset type 2 diabetes. One UK study showed that those who are diagnosed with type 2 diabetes at the of age 45 had an 80% chance of developing cardiorenal disease during their lifetime.7
The authors of this review state their opinion that it is quite likely that those diagnosed below the age of 40 year will have a similar or even greater risk of these complications. Comprehensive and intensive diabetes management is therefore crucial to improve the poor prognostic outlook for those with younger onset type 2 diabetes.
Since cardiovascular disease is so closely related to the presence of diabetes, the active treatment of cardiovascular risk factors should also receive full attention of clinicians to mitigate against the possibility early mortality in younger diabetics.9
This support promulgation of the principles of care which are espoused by the National Health Service in England which launched the T2Day programme, which is meant to improve the care of young people living with type 2 diabetes through diabetes management, improved weight management as well as cardiovascular risk interventions.
The modifiable risk of obesity highlights the need for effective weight management programs since those with younger onset type 2 diabetes are likely to have obesity.10 The authors urge that national guidelines to inform clinicians about evidence-based and cost-effective interventions for young people with type 2 diabetes are urgently needed. As a societal imperative it should be noted that these complications are occurring when the subjects are typically at their most economically productive age. They urge more research be funded to fulfil this need.
The UK Prospective Diabetes Study With Up To 30 Years of Follow-up
Comparing Young With Later-Onset Type 2 diabetes
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00242-0/fulltext
This study confirms that those with younger-onset type 2 diabetes have an accelerated timeline of complications. For this study data was collected for 30 years between 1977 and 2007. The participants were aged 25–65 years when newly diagnosed with type 2 diabetes.
They defined younger-onset diabetes as younger than 40 years and later-onset as 40 years or older. They analysed standard mortality statistics using UK general population data, and incidence rates of different health and mortality outcomes by 10-year age intervals after diagnosis.
Of the over 4500 study participants 9.4 % had younger-onset type 2 diabetes. The median follow-up period was 17·5 years. The mortality rate was significantly higher for younger-onset type 2 diabetics than for the older onset diabetics. And the incidence rates of diabetes complications were also higher in the younger onset diabetics at any given follow up age. Specifically, they showed that not only all cause mortality, but the incidence of myocardial infarction and microvascular disease, and was higher with a younger age at diagnosis. Annual mean HbA1c was also higher in the younger-onset diabetics.
In summary the crucial take away from these studies is that the risk of dying relative to the general population, known to be greater for those diagnosed with diabetes, is even greater for people diagnosed at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes highlights an urgent need for the development of services to identify and manage people with early onset diabetes.
PREVENTING THE PROGRESSION FROM PREDIABETES TO DIABETES
https://drsobo.com/tirzepatide-preventspre-diabetes-to-diabetes/
An important study was just published showing that there is now a high effective treatment which can prevent those with prediabetes from progressing to
diabetes. The medication tirzepatide (brand names Monjauro and Zepbound) is currently approved both for the treatment of diabetes as well as for weight loss. This study evaluated 1,000 pre-diabetic patients who were monitored for 3 years. This study showed that tirzepatide reduced the risk of prediabetes progressing to frank diabetes was reduced by an amazing 94% when the study participants taking tirzepatide were compared with those given a placebo for the study. The study participants also showed that they had a sustained weight loss during the three year treatment period. https://pmlive.com/pharma_news/eli-lillys-gip-glp-1-receptor-agonist-tirzepatide-shown-to-significantly-reduce-type-2-diabetes-risk/
Tirzepatide works by targeting two hormones which are related to the phenomena of appetite control and fat deposition- glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). The weekly injections diminish the desire for food and control blood glucose levels. People who are at a high risk for developing diabetes can to lose weight, control their diabetes predisposition and avoid the progression from prediabetes to actual diabetes. Michael Weintraub, MD from NYU Langone Health says, “We don’t have any medication approved to treat prediabetes right now. If we can intervene earlier and treat the underlying obesity before it leads to Type 2 diabetes or other complications, then that’s going to reduce the overall risk of the No. 1 killer of individuals with obesity, which is cardiovascular disease.” https://time.com/7017001/tirzepatide-zepbound-weight-loss-drug-diabetes/
Preventing Diabetes Lowers the Risk of Other Diseases
Diabetes itself is a worrisome condition to develop because there are many other serious health problems associated with diabetes.
Diabetics have an increased risk of:
- Cardiovascular Disease – heart attack, stroke and cardiac deaths. A study published in the prestigious New England Journal of Medicine has found that the GLP-1 weight loss drug semaglutide reduced the risk of cardiac death by 20%.
- Dementia https://drsobo.com/lower-dementia-risk-eliminating-these-14-risk-factors/ https://drsobo.com/healthy-diet-reduces-dementia-risk-and-slows-aging/
- Kidney problems – the leading cause of needing dialysis treatment for kidney failure is having diabetes.
- Nerve damage – diabetic neuropathy is a painful condition most commonly affecting the legs and feet- there is no cure, and medications are often not very effective.
- Gum disease – Excess sugar in the bloodstream causes too much sugar in saliva which promotes gum and dental disease.
- Cancer – It is estimated that 4-8% of all cancers are obesity related. Obesity is a risk factor for many types of cancer including breast, uterine, kidney, gallbladder, liver and pancreatic cancers as well as colorectal cancer.
- Sexual dysfunction in both men and women.
