Outcomes in youth-onset type 2 diabetes during the transition period: glycemic control, microvascular complications, and effects of second-line agents.

Abstract

Purpose: Despite the global paradigm emphasizing earlier and more aggressive intervention for youth-onset type 2 diabetes mellitus (T2DM), metformin and insulin are the only drugs approved for Korean adolescents. We investigated the incidence of complications, changes in glycemic control during the transition period, the effect of second-line antidiabetic agents on glycemic control in young adults with youth-onset T2DM.

Methods: Eighty-four patients diagnosed with T2DM at Seoul National University Children's Hospital between January 2001 and July 2023, before age 18 (47 males; mean age, 14 years) with available glycated hemoglobin (HbA1c) data from at least 2 distinct ages between 19 and 22 years old were retrospectively enrolled.

Results: At the last follow-up (mean age, 24.9 years; median follow-up, 9.6 years), complications were found in 33.7% (nephropathy, 25.3%; eye disease, 20.6%), and 83% required insulin or second-line agents. During the transition period, HbA1c levels decreased from 8.2% at age 19 to 7.7% at age 22 (P<0.01), with greater improvements in females, those diagnosed before age 15, and those with HbA1c levels ≥7% at age 19. HbA1c level decreased significantly at 1 year after the addition of second-line medications (P=0.03) and at the last visit (P=0.03) compared with baseline.

Conclusion: Glycemic control improved during the transition period among youth-onset T2DM patients. Given the high incidence of complications and the beneficial effects of second-line agents on glycemic control, there is an urgent need to expand the range of approved second-line agents, along with broader insurance coverage in adolescence.