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World J Diabetes. May 15, 2024; 15(5): 876-885
Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.876
Challenges and pitfalls of youth-onset type 2 diabetes
Lavinia La Grasta Sabolic, Sanda Marusic, Maja Cigrovski Berkovic
Lavinia La Grasta Sabolic, Department of Pediatric Endocrinology and Diabetology, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
Lavinia La Grasta Sabolic, School of Medicine, Catholic University of Croatia, Zagreb 10000, Croatia
Sanda Marusic, Maja Cigrovski Berkovic, Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology , Zagreb 10000, Croatia
Author contributions: La Grasta Sabolic L and Cigrovski Berkovic M contributed to the conception and design of the manuscript; La Grasta Sabolic L and Marusic S reviewed the literature and drafted the manuscript; La Grasta Sabolic L analyzed and interpreted the data; Cigrovski Berkovic M critically revised the manuscript; All authors approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maja Cigrovski Berkovic, MD, PhD, Associate Professor, Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Horvacanski Zavoj 15, Zagreb 10000, Croatia. maja.cigrovskiberkovic@gmail.com
Received: December 13, 2023
Peer-review started: December 13, 2023
First decision: January 24, 2024
Revised: February 4, 2024
Accepted: April 1, 2024
Article in press: April 1, 2024
Published online: May 15, 2024
Abstract

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) are increasing. The rise in frequency and severity of childhood obesity, inclination to sedentary lifestyle, and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications. Indeed, youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM, with greater insulin resistance and more rapid deterioration of beta cell function. Therefore, intermediate complications such as microalbuminuria develop in late childhood or early adulthood, while end-stage complications develop in mid-life. Due to the lack of efficacy and safety data, several drugs available for the treatment of adults with T2DM have not been approved in youth, reducing the pharmacological treatment options. In this mini review, we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Keywords: Youth-onset type 2 diabetes mellitus, Insulin resistance, Beta cell failure, Risk factors, Therapy, Complications

Core Tip: Youth-onset type 2 diabetes mellitus (T2DM) is a growing medical challenge, affecting children and adolescents worldwide. Its clinical course is often more aggressive than in type 1 or adult-onset type 2 diabetes, with earlier development of complications. Results of lifestyle interventions have been disappointing, yet the available pharmacotherapy options for children and adolescents with T2DM are still more limited than for adult patients. The introduction of newer agents that target glycemic control, but also promote weight loss and offer cardiovascular and renal benefits, has the potential to significantly improve the health trajectory of youth with T2DM.