Early Versus Late Diagnosis of Youth-Onset Type 2 Diabetes

Objective

To determine if earlier age of diabetes onset (< 15 years of age) is associated with a worse metabolic phenotype compared to diabetes diagnosed at a later age (≥ 15 years of age).

Methods

Retrospective cross-sectional study of our clinical cohort was performed at a tertiary clinic between 2018 and 2023. Diabetes presentation (diabetic ketoacidosis, C-peptide levels, ketonuria), metabolic phenotype (body mass index (BMI) z-score, hypertension, dyslipidemia, elevated liver enzymes, and haemoglobin A1c) were compared between youth diagnosed with type 2 diabetes who were < 15 years of age and those ≥ 15 years of age. A p value of < 0.05 was considered significant.

Results

We studied n = 336 youth. Mean age was 14.5 years at type 2 diabetes diagnosis, n = 198 were < 15 years and n = 138 were ≥ 15 years old. Youth diagnosed at < 15 years versus ≥ 15 years old had a lower systolic and diastolic blood pressure (121.0 ± 12.0 vs. 125.0 ± 12.3 mmHg, p = 0.004 and 72.0 ± 9.8 vs. 74.9 ± 11.1 mmHg, p = 0.013 respectively), and higher HDL cholesterol (38.3 ± 11.7 vs. 35.7 ± 8.7 mg/dL, p = 0.049). There were no differences in the frequency of diabetic ketoacidosis, urine ketones at presentation, C-peptide concentrations, haemoglobin A1c, liver enzymes, total or LDL cholesterol, or BMI z-scores by age group.

Conclusions

A worse metabolic profile was not observed in youth diagnosed at a younger age. In fact, youth who were at an older age at diabetes diagnosis tended to have higher blood pressure and lower HDL-C. Establishing the risk factors for why some youth develop type 2 diabetes at earlier ages is needed.