Patel Dhruva, Shah Amy S, Magella Bliss, Bahrainian Mozhdeh, Brown Elizabeth A, Liu T Y Alvin, Shah Veeral, Channa Roomasa, Wolf Risa M
Department of Pediatrics, Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Department of Pediatrics, Division of Endocrinology, Cincinnati, OH, USA.
J Diabetes Complications. 2025 Sep;39(9):109091. doi: 10.1016/j.jdiacomp.2025.109091. Epub 2025 May 26.
The TODAY2 study reported that 80 % of young adults with youth-onset T2D (YoT2D) had at least one diabetes comorbidity or complication at a mean duration of 13 years. Prevalence rates of comorbidities and microvascular complications in YoT2D with shorter duration and younger age is unclear, particularly in the age of new pharmacotherapies.
In a multicenter retrospective analysis, presence of comorbidities (hypertension (systolic BP > 130 or diastolic BP > 80), dyslipidemia (LDL > 130 mg/dL or triglycerides>150 mg/dL), elevated liver enzymes (AST > 25 U/L, or ALT U/L > 22 for females or >26 U/L for males)) and microvascular complications (microalbuminuria (microalbumin/creatinine ratio > 30), diabetic retinopathy) in patients with YoT2D at three academic pediatric diabetes centers were assessed. Ordinal logistic regression models assessed the associations between demographic and clinical variables and increased odds of either comorbidities or complications.
The study included 298 youth (median age 16.6 years, 60 % female, 57 % Black, 14 % Hispanic). The median duration of T2D was 1.8 years, median HbA1c was 6.9 % (42 % had an HbA1c < 6.5 %). Over 80 % of patients had at least 1 comorbidity, 29 % with hypertension, 49 % with dyslipidemia, and 56 % with elevated liver enzymes. In the cohort, 21 % had at least 1 microvascular complication, 17 % with microalbuminuria, and 4.6 % with diabetic retinopathy. Proportion using GLP-1 receptor agonists and SGLT-2 inhibitors were 36 % and 7 %, respectively. Higher HbA1c and BMI increased the odds of having an additional comorbidity or complication, and longer diabetes duration increased the odds of having microvascular complications.
This study found comorbidities and microvascular complications in YoT2D at younger ages and short duration of diabetes despite use of new medications. Efforts are needed to improve glycemic control and other risk factors to reduce diabetes-related complications in YoT2D.
TODAY2研究报告称，在平均病程为13年的青年起病2型糖尿病（YoT2D）患者中，80%至少有一种糖尿病合并症或并发症。病程较短且年龄较轻的YoT2D患者中合并症和微血管并发症的患病率尚不清楚，尤其是在有新药物治疗的时代。
在一项多中心回顾性分析中，评估了三个学术性儿科糖尿病中心的YoT2D患者中合并症（高血压（收缩压>130或舒张压>80）、血脂异常（低密度脂蛋白>130mg/dL或甘油三酯>150mg/dL）、肝酶升高（谷草转氨酶>25U/L，女性谷丙转氨酶U/L>22或男性>26U/L））和微血管并发症（微量白蛋白尿（微量白蛋白/肌酐比值>30）、糖尿病视网膜病变）的情况。有序逻辑回归模型评估了人口统计学和临床变量与合并症或并发症几率增加之间的关联。
该研究纳入了298名青少年（中位年龄16.6岁，60%为女性，57%为黑人，14%为西班牙裔）。2型糖尿病的中位病程为1.8年，中位糖化血红蛋白为6.9%（42%的患者糖化血红蛋白<6.5%）。超过80%的患者至少有一种合并症，29%患有高血压，49%患有血脂异常，56%肝酶升高。在该队列中，21%至少有一种微血管并发症，17%有微量白蛋白尿，4.6%有糖尿病视网膜病变。使用胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂的比例分别为36%和7%。较高的糖化血红蛋白和体重指数增加了出现额外合并症或并发症的几率，而较长的糖尿病病程增加了出现微血管并发症的几率。
本研究发现，尽管使用了新药物，但在年龄较小且糖尿病病程较短的YoT2D患者中仍存在合并症和微血管并发症。需要努力改善血糖控制和其他危险因素，以减少YoT2D患者中与糖尿病相关的并发症。
