Why early onset type 2 diabetes is more dangerous? –Ping ZhangIn recent years, with the improvement of people’s living standards and lifestyle changes, the incidence of type 2 diabetes has increased rapidly. Type 2 diabetes has become a global epidemic and a major cause of death and disability among adult patients, which has imposed a huge burden on public health and the economy. Currently, the onset of type 2 diabetes tends to be at a younger age, with an age of onset of less than 40 years defined as early onset type 2 diabetes. Early-onset and non-early-onset type 2 diabetics share impaired β-cell function and insulin resistance, but the rate of β-cell failure is more rapid in early-onset type 2 diabetics. In adolescent-onset type 2 diabetes, glycemic control is more difficult, obesity, hyperlipidemia is more severe, and microalbuminuria is more likely to occur. These factors will increase the incidence of diabetes complications and cardiovascular disease. By 2025, there will be 300 million people with diabetes worldwide. The prevalence of diabetes is increasing not only in young people but also in children and adolescents. A recent Japanese study on the incidence of diabetes in children and adolescents found that type 2 diabetes accounted for 5%, 49.1%, and 74.8% of children and adolescents aged 0-9 years, 10-19 years, and 10-29 years, respectively.The decline in the age of onset of type 2 diabetes is largely attributed to the obesity problem in modern society. Over the past decade or so, the incidence of obesity among adults aged 18-29 years in the United States has increased by 70%, and the incidence of type 2 diabetes among adults aged 30-39 years has also increased by 70%, making young adults a rapidly prevalent group for obesity and type 2 diabetes. In the United Kingdom, obesity among people under 18 years of age increased by 63.5% between 1996 and 2003, which was accompanied by a 44.4% increase in the incidence of diabetes. Thus, the increase in obesity among children and adolescents will lead to higher rates of diabetes-related hospitalization in younger populations, resulting in a significant socioeconomic burden.
Patients with early-onset type 2 diabetes have impaired β-cell function and insulin resistance, and the early-onset type 2 diabetes group has poor glycemic control, with approximately 80% requiring more insulin therapy than the late-onset group. Although both the early-onset and late-onset groups had impaired pancreatic B-cell function and decreased insulin sensitivity, beta-cell failure was more rapid in the early-onset group.
Patients with early-onset type 2 diabetes have poorer glycemic control and have severe dyslipidemia. Hyperglycemia is an independent risk factor for the development of cardiovascular disease in type 2 diabetes. Regardless of the treatment modality, the metabolic disorders of type 2 diabetes will progressively worsen as the disease progresses. Younger patients have higher basal blood glucose at initial diagnosis and have difficulty keeping blood glucose under control at stable levels even after treatment, and more of them require early insulin therapy compared to older patients, and even after treatment HbA1C decreases, blood glucose levels remain higher compared to the older group. Another contributor to increased cardiovascular mortality is diabetic dyslipidemia. Total plasma cholesterol and triglycerides are not significantly different in people with early-onset type 2 diabetes compared with those without early-onset type 2 diabetes, but high-density lipoprotein (HDL) is significantly lower and low-density lipoprotein (LDL) is significantly higher in the early-onset group.
Early onset type 2 diabetes is associated with increased morbidity and mortality from atherosclerotic vascular disease and diabetes-related complications due to longer exposure to risk factors. From a societal perspective, there will be a reduction or loss of capacity in the younger workforce and an accompanying significant economic burden to treat diabetes-related complications. Over the next 5 years, early-onset type 2 diabetes will become more prevalent globally as obesity increases. In the face of the increasing trend of early onset type 2 diabetes, an increasing number of people at risk will be screened for diabetes. Once the diagnosis is clear, screening for associated cardiovascular disease risk factors will achieve good glycemic control and reduce the cardiovascular risk of diabetes.