The increasing prevalence of type 2 diabetes mellitus and its associated complications in young people mean better approaches and management of both are urgently needed, conclude authors of a Review published in this week’s issue of The Lancet.
The Review adds that the poor adherence of adolescents with type 2 diabetes to treatment programmes could place them at high-risk of developing these early complications.
Dr Orit Pinhas-Hamiel, Pediatric Endocrinology and Diabetes Department, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and Dr Philip Zietler, Department of Pediatrics, University of Denver, Colorado, USA reviewed a range of reports on acute and long-term illness associated with type 2 diabetes in young people.
The reports reviewed indicate that these complications are being identified at an early age and usually at the time of diagnosis. Furthermore, studies to date suggest that early onset of type 2 diabetes in adolescents is associated with a more rapid progression of complications than type 1 diabetes.
The authors say: "With the rise in prevalence of type 2 diabetes mellitus in adolescents, a rise in incidence of secondary co-morbidities – including hypertension, hyperlipidaemia, nephropathy and retinopathy – is anticipated."
They add: "To date, reports of the epidemiology and natural history of secondary complications specifically in adolescents with type 2 diabetes have been scarce. Yet we must begin to understand this coming challenge."
The chronic complications associated with type 2 diabetes explored in the Review include hypertension, nephropathy, retinopathy, dyslipidaemia, non-alcoholic fatty liver disease and neuropathy.
Psychiatric disorders can also be associated with type 2 diabetes – with one in five adolescents in a study from Philadelphia, USA, suffering from conditions such as depression, obsessive-compulsive disorder or one of a range of other neuropsychiatric diseases.
The unborn children of pregnant young women and girls diagnosed with type 2 diabetes are also at increased risk. A Canadian study of 51 girls aged 17 years and under all diagnosed with type 2 diabetes revealed only 35 live births were recorded – a pregnancy loss rate of 38%.
Acute complications such as diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and malignant hypothermia like syndrome, have all been found in studies to be more prevalent in adolescents with type 2 diabetes. One study reports the deaths of seven young black African-American males (aged 13-21 years) with previously undiagnosed diabetes. Review of their records later indicated they met the criteria for hyperglycaemic hyperosmolar state.
The authors conclude: "These findings, although still limited, suggest that we urgently need to develop approaches to awareness and early management of type 2 diabetes and associated abnormalities while designing long term studies to establish the value of early initiation of adjunctive treatments."
Journal
The Lancet