The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study randomized 699 participants newly diagnosed with type 2 diabetes (T2D) to one of three groups (metformin, metformin + rosiglitazone, or metformin + intensive lifestyle changes) and documented the aggressive nature of T2D in youth1 . TODAY22 was a follow-up study and included 572 of the original participants over the subsequent decade following completion of the 48-month randomized portion of the study. Together, the studies provide longitudinal data on the complications occurring in youth-onset T2D over a combined 15-year period.
At the beginning of the combined study period, HbA1C levels were less than 8% in all participants. By year 15 of the combined study period, 59% of all participants had HbA1C levels of 8% or greater, with 34% of all participants at 10% or greater. Diabetes complications accumulated rapidly and progressively, with 60% of participants developing a microvascular complication, defined as new-onset kidney, nerve, or retinal disease. By comparison, microvascular complications were reported in only 25% of youth with type 1 diabetes during a comparable length of time3 . Complications were more frequent in participants of minority race and ethnic groups and in those with hyperglycemia, hypertension, and dyslipidemia.
The TODAY2 study results highlight the challenges of controlling glucose and preventing complications in youth with T2D. Future intervention studies are critical to prevent and manage T2D in youth overall and in those at highest risk for developing complications.
- TODAY Study Group, Zeitler P, Hirst K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes.
N Engl J Med. 2012;366(24):2247-2256. doi:10.1056/NEJMoa1109333.
- Bjornstad P, Drews KL, Caprio S, et al. Long-term complications in youth-onset type 2 diabetes.
N Engl J Med. 2021;385(5):416-426. doi:10.1056/NEJMoa2100165.
- Amin R, Widmer B, Prevost AT, et al. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study.
BMJ 2008;336:697-701. doi:10.1136/bmj.39478.378241.BE.