Youth-Onset Type 2 Diabetes Consensus Report: Current Status, Challenges, and Priorities

Abstract

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.

Figure 1

Prevalence of youth-onset type 2 diabetes by race/ethnicity. 2009 prevalence of type 2 diabetes among youth, as published by the SEARCH for Diabetes in Youth study (4). Prevalence is reported per 10,000 population at risk for type 2 diabetes (ages 10–19 years). AA, African American; AI, American Indian; API, Asian Pacific Islander; H, Hispanic; NHW, non-Hispanic white.

Figure 2

β-Cell failure rates in adults versus youth with type 2 diabetes. A comparison of medication treatment failure rates and percent change in surrogate measures of insulin sensitivity and β-cell function as reported in the TODAY study (youth) versus adult studies (A Diabetes Outcome Progression Trial [ADOPT], U.S. Department of Defense Database [US DOD], and UK Prospective Diabetes Study [UKPDS]). Note that the studies had different primary end points and therefore this is an approximate comparison, as there have been no head-to-head comparisons (,,–16,67,68). Met, metformin; Rosi, rosiglitazone.

Figure 3

Few patients with youth-onset type 2 diabetes are available to participate in clinical trials. The population of youth-onset type 2 diabetes is small, approximately 20,000–25,000 in the U.S., compared with the approximately 20 million adults. Barriers to clinical trial participation include the paucity of centers with dedicated resources for pediatric type 2 diabetes trials, SES challenges inherent to the population, and the many study entry requirements that exclude study eligibility before and after formal study screening procedures (69). T2D, type 2 diabetes. *Numbers are from Imperatore et al. (69).