Diabetes in Young Adult

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Diabetes in Young Adult
Eva Decroli
8th DOC LINK 2014 Plenary Discussion
Definition
Type 2 diabetes (T2DM) in youth is coming increasingly into focus given its rising incidence
and prevalence, tracking together with childhood obesity. For those with young-onset T2DM, the
increased lifetime exposure to hyperglycemia predicts a high complications risk over time.
Moreover, there is evidence for an increased inherent susceptibility to complications, namely
retinopathy in diabetes presenting earlier rather than later in life.1
MODY (Maturity-Onset Diabetes of the Young) is:


Type-2 diabetes mellitus in the young plus autosomal dominant inheritance.



A heterogeneous disorder due to heterozygous monogenic mutations in one of at least 6
different genes.



Onset of diabetes early in life: childhood, adolescence, young adulthood.



Autosomal dominant inheritance.



Primary defect in insulin secretion.

Screening
The American Diabetes Association (ADA) and the American Academy of Pediatrics (AAP)
released screening guidelines in 2000 for identifying children with T2D. These guidelines
recommended that children with body mass index ≥ 85th percentile and any two additional risk
factors be screened with a fasting plasma glucose (FPG) or a 2-hour glucose tolerance test
(OGTT) every 2 years starting at age 10 years, or at onset of puberty.
Although the FPG and the 2-hour OGTT were recommended as screening tests, they are also the
gold standard tests for diagnosing diabetes. However, in 2010, the ADA modified its diagnostic

guidelines, recommending that HbA1c tests also be used for diagnosing diabetes (HbA1c ≥
6.5%) and prediabetes (HbA1c = 5.7%-6.4%) in both adults and children. The rationale for a
shift to HbA1c was that it does not require patients to fast prior to fasting, has a lower variability,
and has been linked to the development of diabetes complications in epidemiologic studies.
However, the guidelines are not without controversy, particularly in the pediatric population,
given concern about nonglycemic test factors impacting HbA1c and lower test performance of
HbA1c for children compared with adults.2
Risk Factor
Obesity and related risk factors of type 2 diabetes (T2D) and cardiovascular diseases (CVDs) are
of major public health concern, especially in resource-limited countries where the healthcare
costs of chronic diseases are increasing. The prevalence of T2D in youth has increased and
currently affects over 10,000 individuals. Risk factors for CVDs such as obesity, hypertension,
hyperlipidaemia, family history of T2D, and rare/ethnicity are common among adolescents.
Adolescents are consuming more high-fat, energy-dense foods and enganging in decreased
physical activity, which mimics the lifestyle. The relationship of T2D and expression of CVDs
has not been adequately in adolescent population. High BMI and central adiposity are two wellrecognised risk factors of T2D and CVDs.3
Etiology
Clinicians who manage diabetes arising in young adults are faced with a wide range of
underlying etiologies, which includes type 2 diabetes, autoimmune diabetes, and a large number
of less common causes. Despite the clinical benefits of assigning an accurate diagnostic label,
detailed etiological assessment, a key part of the diagnostic process, is frequently neglected.4
Treatment
Metformin monotherapy provided durable glycemic control in only half the patients. The
combination of metformin and rosiglitazone improved the durability of glycemic control. The
metformon combined with lifestyle intervention was no better than metformin alone in
maintaining glycemic control.5

Complication
Type 2 diabetes mellitus in youth is a relatively new problem, and there are few data on longterm survival or complications to substantiate this prediction.1

Reference
1. Maria IC. Long-term Complications and Mortality in Young-Onset Diabetes. 2013.
2. Joyce ML, et al. Screening Practices for Identifying Type 2 Diabetes in Adolescents.
2013.
3. Sheila CB, et al. A Cross Sectional study of Jamaican adolescents’ Risk for Type 2
Diabetes and Cardiovascular Diseases. 2013.
4. Gaya T, et al. Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of
Young-Onset Type 2 Diabetes is a Successful Strategy for Identifying Maturity-Onset
Diabetes of the Young. 2011.
5. Phil Z. A Clinical Trial to maintain Glycemic Control in Youth with Type 2 Diabetes.
2012.

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