Savage Matthew J, Goldney Jonathan, Slater Tommy, Sarkar Priscilla, Sargeant Jack A, Wilmot Emma G, Davies Melanie J
Diabetes Research Centre, University of Leicester, Leicester, UK.
NIHR Leicester Biomedical Research Centre, Leicester, UK.
Diabetes Metab J. 2025 Sep;49(5):934-950. doi: 10.4093/dmj.2025.0561. Epub 2025 Sep 1.
The global prevalence of early-onset type 2 diabetes (EOT2D) is rising rapidly. Adults with EOT2D represent a high-risk population characterised by increased rates of microvascular and macrovascular complications, adverse psychological wellbeing and psychiatric comorbidities such as depression, and premature mortality compared to those with later-onset type 2 diabetes mellitus. This emerging population faces unique challenges, including high levels of diabetes-related stigma, clinical inertia, and competing life demands, such as starting a family. This review synthesises current evidence on the clinical management of EOT2D. Key therapeutic targets include weight reduction, preservation of β-cell function, cardiometabolic risk management, and psychological support. Overall, there are few randomized controlled trials (RCTs) undertaken specifically in adults with EOT2D. However, we summarise early data from the few RCTs that do report outcomes specific in young adults, with bariatric surgery, tirzepatide and intensive lifestyle interventions emerging as particularly effective treatments. There is a strong rationale that technology-based inventions and structured education programs may prove to be effective treatments but data from RCTs is lacking. We provide broad recommendations for future research and clinical practice based on the current evidence. In conclusion, substantial further research is required to inform tailored, evidence-based guidelines and improve long-term outcomes in this underserved population.
早发型2型糖尿病（EOT2D）的全球患病率正在迅速上升。与晚发型2型糖尿病患者相比，EOT2D成人患者是一个高危人群，其特征是微血管和大血管并发症发生率增加、心理健康状况不佳以及存在抑郁症等精神疾病合并症，且过早死亡。这一新兴人群面临着独特的挑战，包括与糖尿病相关的高度耻辱感、临床惰性以及诸如组建家庭等相互冲突的生活需求。本综述综合了关于EOT2D临床管理的现有证据。关键治疗靶点包括体重减轻、β细胞功能保留、心脏代谢风险管理和心理支持。总体而言，专门针对EOT2D成人患者进行的随机对照试验（RCT）很少。然而，我们总结了少数RCT的早期数据，这些试验确实报告了针对年轻人的特定结果，其中减肥手术、替尔泊肽和强化生活方式干预已成为特别有效的治疗方法。有充分的理由认为，基于技术的发明和结构化教育计划可能被证明是有效的治疗方法，但缺乏RCT的数据。我们根据现有证据为未来的研究和临床实践提供广泛建议。总之，需要进行大量进一步研究，以制定量身定制的、基于证据的指南，并改善这一未得到充分服务人群的长期结局。
