Peer Reviewed
Feature Article Endocrinology and metabolism

Young adult-onset type 2 diabetes: adverse outcomes and potential solutions

Angela S Lee, Jencia Wong
Abstract
Until recently, type 2 diabetes was considered a lifestyle disease of mature people and less serious than type 1 diabetes. Young adult-onset type 2 diabetes has been revealed to be an aggressive condition with a high risk of diabetes complications and premature death, a risk greater than for those with type 1 diabetes.
Key Points
  • Early detection of diabetes in young people is extremely important. Practitioners should have a high index of suspicion and consider targeted testing in young adults with high-risk features.
  • Obesity is the most prevalent modifiable risk factor and a strong family history or a history of in utero exposure to hyperglycaemia is associated with a younger onset of type 2 diabetes.
  • Patients with young adult-onset type 2 diabetes have a high risk and prevalence of diabetic complications, often present at diagnosis.
  • Given a high lifetime risk of complications, tight glycaemic control early in the diabetes disease process is likely to yield the greatest benefit for prevention.
  • Monotherapy failure rate is higher than in older patients with type 2 diabetes.
  • Mortality is driven by premature macrovascular disease, so cardiovascular disease risk factors should be attended to early.
  • Clinicians should be aware that medication adherence is demonstrably low and psychosocial issues are frequent in this patient group and many are lost to follow up.
  • Young adult-onset type 2 diabetes should be recognised as an aggressive disease requiring early intervention and multidisciplinary support, irrespective of the need for insulin therapy.

    Picture credit: © IStockphoto/Tina Lorien. Model used for illustrative purposes only.

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