NIH Record - National Institutes of Health

Youth-Onset Type 2 Diabetes Complications Arise by Young Adulthood

Young woman uses a finger-stick device.
Youth-onset type 2 diabetes is more aggressive than adult-onset diabetes.


People with type 2 diabetes diagnosed during youth have a high risk of developing complications at early ages and have a greater chance of multiple complications within 15 years after diagnosis. The findings are the culmination of a first-of-its-kind trial funded largely by NIDDK.

Within 15 years of a type 2 diabetes diagnosis, 60 percent of participants had at least 1 diabetes-related complication, and nearly a third of participants had 2 or more complications, according to results of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) follow-up study, called TODAY2. The findings were published in the New England Journal of Medicine.

“The original TODAY study showed that youth-onset type 2 diabetes is distinct from adult-onset diabetes; it is both more aggressive and more difficult to control,” said Dr. Barbara Linder, NIDDK project scientist. 

TODAY2 involved 500 original participants from the TODAY study, which began in 2004. The study, conducted at 15 centers across the country, compared 3 treatments for managing blood glucose: metformin—the only FDA-approved oral medication to treat type 2 diabetes in youth—alone or combined with another medication or intensive lifestyle intervention.

Overall, researchers saw a steady decline in blood glucose control over 15 years. In addition, 67 percent of participants had high blood pressure. Nearly 52 percent had dyslipidemia, or high fat levels in the blood. Nearly 55 percent had kidney disease; 32 percent had nerve disease and 51 percent had diabetic eye disease. 

“Compared to what we see in adults with type 2 diabetes, the participants in TODAY2 developed complications much earlier in their disease course and at a much faster pace over time,” said TODAY2 study chair Dr. Philip Zeitler of the University of Colorado School of Medicine. The findings underscore the importance of early, intensive treatment.

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