Abstract Youth-onset type 2 diabetes (T2D) is increasing around the globe. The mounting disease burden of youth-onset T2D portends substantial consequences for the health outcomes of young people and ...for health care systems. The pathophysiology of this condition is characterized by insulin resistance and initial insulin hypersecretion ± an inherent insulin secretory defect, with progressive loss of stimulated insulin secretion leading to pancreatic β-cell failure. Research studies focusing on youth-onset T2D have illuminated key differences for youth- vs adult-onset T2D, with youth having more profound insulin resistance and quicker progression to loss of sufficient insulin secretion to maintain euglycemia. There is a need for therapies that are targeted to improve both insulin resistance and, importantly, maintain sufficient insulin secretory function over the lifespan in youth-onset T2D.
The incidence of youth type 2 diabetes (T2D), linked with obesity and declining physical activity in high‐risk populations, is increasing. Recent multicenter studies have led to a number of advances ...in our understanding of the epidemiology, pathophysiology, diagnosis, treatment, and complications of this disease. As in adult T2D, youth T2D is associated with insulin resistance, together with progressive deterioration in β cell function and relative insulin deficiency in the absence of diabetes‐related immune markers. In contrast to adult T2D, the decline in β cell function in youth T2D is three‐ to fourfold faster, and therapeutic failure rates are significantly higher in youth than in adults. Whether the more aggressive nature of youth T2D is driven by genetic heterogeneity or physiology/metabolic maladaptation is yet unknown. Besides metformin, the lack of approved pharmacotherapeutic agents for youth T2D that target the pathophysiological mechanisms is a major barrier to optimal diabetes management. There is a significant need for effective therapeutic options, in addition to increased prevention, to halt the projected fourfold increase in youth T2D by 2050 and the consequences of heightened diabetes‐related morbidity and mortality at younger ages.
Poor sleep and obesity are both extraordinarily common in the US adolescent population and often occur simultaneously. This review explores the links between obesity and sleep, outlining what is ...known about the relationships between sleep characteristics, obesity, and cardiometabolic risk factors in youth. Sleep duration is less than optimal in teens, and decreases as age increases. This is detrimental to overall well-being and is associated with obesity in children, adolescents, and young adults. Accordingly, inadequate sleep duration is associated with poor diet quality, decreased insulin sensitivity, hyperglycemia, and prevalent cardiometabolic risk factors. Evidence suggests that poor sleep quality and altered circadian timing characterized by a preferred later sleep onset, known as "adolescent chronotype," contributes to shortened sleep duration. Obstructive sleep apnea (OSA) occurs more frequently among youth with obesity, and is associated with autonomic nervous system activity promoting higher blood pressure, increased markers of cardiovascular disease risk, and insulin resistance. While there is a clear association between OSA and type 2 diabetes in adults, whether or not this association is prevalent in youth is unclear at this time. Interventions to improve both sleep duration and quality, and obesity in adolescents are scarce and more evidence is needed to determine if such interventions can improve obesity-related health outcomes.
Obesity in Adolescents Hannon, Tamara S.; Arslanian, Silva A.
The New England journal of medicine,
07/2023, Volume:
389, Issue:
3
Journal Article
Peer reviewed
Management of obesity in adolescents should routinely include intensive treatment with regard to lifestyle and diet, with antiobesity medications and bariatric surgery considered if indicated.
Obesity in Adolescents. Reply Hannon, Tamara S; Arslanian, Silva A
The New England journal of medicine,
10/2023, Volume:
389, Issue:
14
Journal Article
Abstract
Youth-onset type 2 diabetes is a growing epidemic with a rising incidence worldwide. Although the pathogenesis and diagnosis of youth-onset type 2 diabetes are similar to adult-onset type 2 ...diabetes, youth-onset type 2 diabetes is unique, with greater insulin resistance, insulin hypersecretion, and faster progression of pancreatic beta cell function decline. Individuals with youth-onset type 2 diabetes also develop complications at higher rates within short periods of time compared to adults with type 2 diabetes or youth with type 1 diabetes. The highest prevalence and incidence of youth-onset type 2 diabetes in the United States is among youth from minoritized racial and ethnic groups. Risk factors include obesity, family history of type 2 diabetes, comorbid conditions and use of medications associated with insulin resistance and rapid weight gain, socioeconomic and environmental stressors, and birth history of small-for-gestational-age or pregnancy associated with gestational or pregestational diabetes. Patients with youth-onset type 2 diabetes should be treated using a multidisciplinary model with frequent clinic visits and emphasis on addressing of social and psychological barriers to care and glycemic control, as well as close monitoring for comorbidities and complications. Intensive health behavior therapy is an important component of treatment, in addition to medical management, both of which should be initiated at the diagnosis of type 2 diabetes. There are limited but growing pharmacologic treatment options, including metformin, insulin, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors. Although long-term outcomes are not fully known, metabolic/bariatric surgery in youth with type 2 diabetes has led to improved cardiometabolic outcomes.
Type 2 diabetes is a significant and increasing burden in adolescents and young adults. Clear strategies for research, prevention, and treatment of the disease in these vulnerable patients are ...needed. Evidence suggests that type 2 diabetes in children is different not only from type 1 but also from type 2 diabetes in adults. Understanding the unique pathophysiology of type 2 diabetes in youth, as well as the risk of complications and the psychosocial impact, will enable industry, academia, funding agencies, advocacy groups, and regulators to collectively evaluate both current and future research, treatment, and prevention approaches. This Consensus Report characterizes type 2 diabetes in children, evaluates the fundamental differences between childhood and adult disease, describes the current therapeutic options, and discusses challenges to and approaches for developing new treatments.
Women with previous gestational diabetes mellitus (WPGDM) have high risk for T2D but low rates of engagement in diabetes prevention interventions. We used an informed decision-making strategy with ...WPGDM to promote participation in behavioral interventions. These included group (National Diabetes Prevention Program (DPP) , web-based DPP, modified DPP for families, WW) ; individual (health coaching, digital WW) ; and dietician consult (passive) . We evaluated 1) intervention preferences, and 2) determinants of intervention choices. We used the CoMac Descriptor™ (CoMac) to assess person-centered determinants of intervention choice. CoMac’s 12-question survey categorizes patients into three engagement categories based on locus of control, emotional state, and agency.
Of 116 WPGDM (age 34±7) who participated, 95 chose an intervention. CoMac predicted high (H) , moderate (M) or low (L) engagement with behavioral intervention (63% H; 29% M; 8% L) . Group interventions were chosen by a majority (58%) of participants (53% H, 79% M, 74% L) . Individual interventions were chosen by 34% (33% H, 21% M, 26% L) . Passive interventions were chosen by 8% (13.7% H, 0% M/L) . Participants categorized as H (mean A1C 5.2±.1) chose group interventions just more than half of the time. Participants categorized as M (mean A1C 5.3±.1) and L (mean A1C 5.4±.1) chose group interventions over individual at a higher rate than Hs, nearly three-quarters of the time. Our results show that the majority of WPGDM prefer active over passive behavior interventions. This runs counter to the passive behavioral interventions typically offered in healthcare settings. Results further show that person-centered trait clusters are associated with intervention preference, and CoMac’s patient categorization may help providers to better align interventions with patient preference.
Disclosure
M.Hume: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. R.Sandy: None. U.M.Connor: Other Relationship; CoMac Analytics, Inc.
Funding
Indiana University Grand Challenge Precision Health Initiative
PDF
