Type 2 diabetes in children and adolescents: Exploring the disease heterogeneity and research gaps to optimum management

Table 2 Research gaps and possible solutions

Knowledge gaps in youth-onset T2DM

1 Future studies are needed with larger and more diverse samples to understand the unique aspects of T2DM in children and adolescent

2 What are the physiological barriers to exercise seen in obese youth and youth with T2DM? Are lifestyle interventions successful, durable, and sufficient?

3 What are effective ways to increase compliance with lifestyle interventions and medication in adolescents with T2DM?

4 What medications (alone or in combination) achieve durable glycemic control in youth-onset T2DM? Should disease-modifying therapies (SGLT2 inhibitors and GLP-1 RAs) be deployed earlier in the treatment algorithms?

5 What is the optimal approach to management of comorbidities and complications in youth-onset T2DM?

Possible solutions to barriers

1 Prioritization of clinical and translational research addressing the gaps in knowledge regarding the unique physiological features of youth-onset T2DM

2 Increased explorations of the psychological and socioeconomic aspects of youth-onset T2DM

3 Collaboration among academic leaders, government and charitable sponsors, industry, and regulatory agencies to delineate research strategies

4 Increasing research and infrastructure capacity for youth-onset T2DM through the development of research centers of excellence those are uniquely staffed and maintained

5 Increasing the proportion of youth with T2DM who participate in clinical drug trials through trial designs appropriate for the typical youth with T2DM and creative strategies to overcome barriers to care and research

GLP-1 RA: Glucagon-like peptide 1 receptor agonist; SGLT-2: sodium-glucose cotransporter-2; T2DM: Type 2 diabetes mellitus.