High rate of complications in a real-world cohort of youth with T2D: a multicenter analysis

Dhruva Patel; Amy S Shah; Bliss Magella; Mozhdeh Bahrainian; Elizabeth A Brown; T Y Alvin Liu; Veeral Shah; Roomasa Channa; Risa M Wolf

doi:10.1016/j.jdiacomp.2025.109091

High rate of complications in a real-world cohort of youth with T2D: a multicenter analysis

J Diabetes Complications. 2025 May 26;39(9):109091. doi: 10.1016/j.jdiacomp.2025.109091. Online ahead of print.

Authors

Dhruva Patel¹, Amy S Shah², Bliss Magella², Mozhdeh Bahrainian³, Elizabeth A Brown¹, T Y Alvin Liu⁴, Veeral Shah⁵, Roomasa Channa³, Risa M Wolf⁶

Affiliations

¹ Department of Pediatrics, Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Department of Pediatrics, Division of Endocrinology, Cincinnati, OH, USA.
³ Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
⁴ Wilmer Eye Institute at the Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁵ Abrahamson Pediatric Eye Institute, Division of Pediatric Ophthalmology, Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁶ Department of Pediatrics, Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, MD, USA. Electronic address: RWolf@jhu.edu.

PMID: 40570536
DOI: 10.1016/j.jdiacomp.2025.109091

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Comorbidities; Complications; Type 2 diabetes.