Type 2 Diabetes in Young Adults: A More Aggressive Disease Treated with an Older Playbook
DOI:
https://doi.org/10.5281/zenodo.22261250Keywords:
Youth-onset type 2 diabetes, Beta cell function, Treatment failure, Metformin, Early complicationsAbstract
Type 2 diabetes diagnosed in adolescence and young adulthood behaves differently from the adult-onset disease on which its
treatment is modelled. In the principal randomised trial, 51.8 per cent of participants on metformin monotherapy reached
treatment failure over about four years, and beta cell function declined at 20 to 35 per cent annually, faster than reported in adult
studies. Complications appeared early: after a mean of 3.9 years, 33.8 per cent had hypertension, 16.6 per cent microalbuminuria
and 13.7 per cent retinopathy, in a population still in its teens and twenties. The mechanistic finding matters most for treatment.
Loss of control was driven by rapid beta cell failure rather than by worsening insulin sensitivity, and was not explained by
adherence or body mass index, which is the opposite of the adult pattern. Adding structured lifestyle support to metformin was not
superior to metformin alone, and the arm that performed best was subsequently withdrawn from use in this age group on safety
grounds.
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