Youth-onset type 2 diabetes: Advances, treatments, and challenges in prevention

Youth-onset type 2 diabetes (YOT2D) rates have increased dramatically in the last 20 years paralleling the increase in obesity. The primary pathophysiology is insulin resistance (IR) linked directly to obesity and inflammation within adipose depots. Adipose inflammation and dysfunction lead to increases in triglycerides (TGs) and free fatty acids (FFAs) that in turn impact glucose utilization in other key tissues such as the liver and skeletal muscle.

Screening for diabetes risk in youth is difficult as the current diagnostic criteria yield very few cases that actually progress to overt diabetes, and prevention strategies to delay the onset of YOT2D are lacking.

Identifying the progression towards and early diagnosis of YOT2D is paramount as it is much more aggressive than adult-onset T2D, including early signs of beta cell failure, necessitating rapid intensification of therapy to avoid later complications. Recently, the pharmacologic options for treatment of those <18 years of age have increased which is anticipated to improved outcomes.

Identifying specific factors in youth at the highest risk for progression to youth-onset T2D is needed to move toward more effective prevention and therapeutic strategies with the goal of maintaining health and wellness of this vulnerable population.