Young-onset type 2 diabetes and retinopathy: evidence of an adverse phenotype

The landscape of type 2 diabetes (T2D) has changed with an increasing number of people being diagnosed under age 40 years. The principal concern with young-onset T2D is the early development of complications, with associated morbidity and premature mortality. In view of the potential impact on the working-age population and the associated personal, societal and economic ramifications, it is important to understand the factors that drive the pathogenesis of these complications in order to mitigate or prevent their occurrence. Few studies have investigated the impact of young-onset T2D on microvascular disease such as retinopathy. As one of the leading causes of blindness and visual impairment in adults under age 40 years,1 this is a feared complication among people with diabetes and merits further investigation. In this issue of the journal, Tibballs et al 2 report that young adult-onset T2D, diagnosed between the ages of 18 and 39 years and constituting 10% of the overall population with T2D, had a higher burden of retinopathy and a greater risk of developing this complication, including severe retinal disease, compared with those diagnosed with T2D later in life. Young-onset male subjects were particularly susceptible to this complication. Despite receiving more intensive diabetes treatment, including insulin, the young-onset cohort exhibited more rapid deterioration in glycemic control. Compared with females with T2D, the young-onset males had higher HbA1c at diagnosis and this difference in glycemic control persisted …