Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide-a severe consequence of mental health problems-increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan.

This nationwide longitudinal cohort study included adults aged 18-74 years, who were enrolled in the Japan Health Insurance Association's health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data.

Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18-39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)).

Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.

To design a regional clinical service for people with early-onset type 2 diabetes (EOT2D) in Leicester, Leicestershire and Rutland (England).

A literature search was undertaken to identify important considerations. A working group of key stakeholders was formed to design a triage system and service pathway. Electronic medical records (EMRs) were searched (15th November 2023) to assess feasibility of the pathway and adapt accordingly.

A literature search identified important considerations: High risk of complications; large proportion from minority ethnic and socioeconomically deprived backgrounds; significant psychological burden; stigma and other social challenges; and misclassification and miscoding. Novel clinical risk criteria were developed, implementable in EMRs, to match intervention-intensity to clinical need. Specialist clinics were planned, one for people at the highest-clinical risk, another for women with adverse perinatal risk factors. A healthcare professional training package was developed to increase awareness of the unmet clinical needs of people with EOT2D and to upskill in provision of holistic care. Subsequent EMR searches supported the need for our service. Due to the large numbers with HbA1c ≥86mmol/mol (10.0%; n=299; 10.8% of total), these people were prioritised for clinic access. We opted for specialist nurse/educator support to practices with clustering of patients and to financially incentivise referrals from primary care into services.

We showcase a service specifically for people with EOT2D based on the literature, a broad range of stakeholder involvement and utilising a locally-sourced data-driven approach. We further discuss areas for development and recommendations based on the challenges we encountered.

Despite increasing prevalence, early-onset type 2 diabetes (EOT2D) has received little clinical and qualitative research attention within England. This qualitative study aimed to explore and understand the unmet needs of people living with early-onset type 2 diabetes (PEOT2D) and their diabetes care within England.

Using semi-structured interviews, data was collected, transcribed and analysed from 25 PEOT2D and 25 healthcare professionals (HCPs). Taking an abductive approach, data for both cohorts were analysed and interpreted according to four constructs of Normalisation Process Theory (NPT): coherence (sense-making), cognitive participation (engagement), collective action (enactment) and reflexive monitoring (formal and informal appraisal).

Our findings revealed several unmet needs in current treatment and care for PEOT2D. The main unmet need was access to specialist care. Having GP (general practitioner) practices as their main caregivers presented a significant barrier to this population successfully carrying out their diabetes self-care. HCPs in specialist roles expressed similar views and were keen to see PEOT2D receive access to holistic and specialist care via a multidisciplinary team. Data interpretation according to the four constructs of NPT found that implementation of this approach would involve fostering an environment of support that allowed HCPs across the primary and secondary interface to do the following: (1) provide consultations incorporating person-centred care, shared decision-making, and non-judgemental and non-stigmatising behaviours and (2) work in an integrated and synchronous manner using streamlined referrals, interprofessional collaborations and team-based learning. Provision of tailored financial, human (additional staffing) and learning resources was found to be integral to allow creation of tailored multidisciplinary teams, and individual and collective skill enhancement of both specialist and primary care providers.

Although both PEOT2D and specialist care providers are keen for young adults with EOT2D to receive access to specialist and holistic care, there are several resource barriers that must be addressed to allow implementation of their desired approach to treatment and care. Further qualitative research with primary care providers (for example, GPs and practice nurses) involved in EOT2D care is needed to understand if (and how) their views and experiences differ from those providing specialist care.

To examine whether type 2 diabetes (T2D) duration ('0-4'; '≥5-9'; ≥10-19'; '≥20 years') was associated with use of medication for depression, anxiety, or insomnia, and if possible associations were modified by age, age at T2D onset, sex, and education.

We used data from 55,083 adults with T2D in the national registry-based cohort study Outcomes & Multi-morbidity In T2D (2006-2019). Adjusted associations and effect modifications were estimated using binary logistic regressions with generalized estimation equations in the subgroups age (<60, ≥60 years), age at diabetes onset (<40, ≥40 years), sex (men, women), and education (primary, high school, university).

At initial registration, 12 % used medication for depression, 10 % for anxiety, and 16 % for insomnia. These prevalence estimates increased with diabetes duration in most subgroups. Individuals with early onset T2D had higher prevalence of depression than those with late onset, which increased with diabetes duration (per category change diabetes duration 0.7 % (95 % CI 0.2, 1.2), P for trend = 0.003). For anxiety and insomnia, a stronger association was found in those with early T2D onset compared to late onset (per category change 1.3 % (95 % CI 0.9, 1.8) and 1.9 (95 % CI 1.3, 2.4), P for interaction = 0.001; 0.01).

The prevalence of pharmacologically treated depression, anxiety, and insomnia increased with diabetes duration; this finding may imply that assessment of mental health disorders at the initial phase and along the diabetes trajectory are needed. As the prevalences advanced most prominently in people with early onset T2D, future studies should determine underlying mechanisms to test age-appropriate preventive interventions.

The world-wide prevalence of diabetes distress varies, and studies are mainly undertaken in clinical settings. By using data from the Trøndelag Health (HUNT) study, we aimed to estimate diabetes distress prevalence, its determinants, and associations with anxiety and depression among adults with type 2 diabetes.

This population-based cross-sectional study consists of individuals ≥ 20 years with type 2 diabetes participating in the HUNT4 survey (2017-2019). Diabetes-distress prevalence with 95% confidence interval (CI) was calculated based on the five item Problem Areas in Diabetes (PAID-5) questionnaire. PAID-5 sum scores were rescaled to a 0-100 scale by multiplying the sum score by five. Linear and logistic regression models were used to examine associations of demographic, lifestyle- and clinical factors, with diabetes distress.

In total, 1954 individuals completed the PAID-5 questionnaire, with a mean score of 15.2 (SD 18.3) and 11.9% (95% CI 10.6-13.4) reporting high diabetes distress (PAID-5 ≥ 40). Multivariable linear regression showed that diabetes distress was associated with a 0.2 (95% CI 0.2-0.3) lower score for each year older age, 7.6 (95% CI 5.4-9.7) higher score for current insulin use, and 9.3 (95% CI 5.3-13.2) higher score for a history of diabetes foot ulcers. High levels of anxiety and depression symptoms were associated with higher diabetes distress (Anxiety: B 16.0, 95% CI 13.6-18.4, Depression: B 13.3, 95% CI 10.7-16.0).

Diabetes distress is common and strongly associated with younger age at diabetes onset, insulin use, foot ulcer, and anxiety and depression symptoms. Identifying and addressing diabetes distress in diabetes follow-up may facilitate improving health outcomes and prevent more serious mental health issues in individuals with T2D. Nevertheless, the findings should be further examined in longitudinal studies.

To assess the factors associated with foot self-care behaviour and non-adherence to foot screening among patients with type 2 diabetes mellitus (T2DM).

A multicentre cross-sectional study was undertaken in seven primary care polyclinics in Singapore between October 2020 and December 2021.

275 adults (male 55.3%) with T2DM were included and assessed with the foot self-care behaviour questionnaire, including two aspects of foot care behaviour-preventative behaviour and potential damaging behaviour, and foot care confidence scale. Non-adherence to diabetic foot screening (DFS) attendance was also collected and assessed.

The average preventive behaviour score was 0.65 (SD 0.13, range 0-1) and potential damaging behaviour score was 0.43 (SD 0.09, range 0-1). Patients with greater foot care confidence (β=0.272) and being married (β=0.141) were more likely to adopt preventive behaviours, while patients aged between 21 and 45 years (β=0.136), having shorter DM duration (<5 years) (β=0.142) and moderate foot risk category (β=0.138) were more likely to adopt potential damaging behaviours. Non-adherence to DFS attendance was prevalent up to 43.3%. Non-adherence was higher in patients with higher HbA1c ≥7% (adjusted OR (AOR) 1.878, 95% CI 1.090 to 3.235) and moderate foot risk category (AOR 2.935, 95% CI 1.426 to 7.744).

Self-efficacy and being married are associated with preventive behaviours, while clinical parameters (eg, HbA1c, duration of DM and foot risk category) and age were associated with potential damaging behaviours and non-adherence to DFS appointments. Longitudinal studies are needed to confirm the findings for developing foot behavioural education to support foot care behaviours for primary care patients with T2DM.

The escalating prevalence of type 2 diabetes within the working-age population (18-60 years) imposes a substantial societal burden. Whilst physical activity is crucial for diabetes management, limited evidence exists to inform optimal strategies for promoting physical activity in this population. We aimed to evaluate and compare the effect of interventions for increasing physical activity in working-age adults with type 2 diabetes.

We searched Web of Science, the Cochrane Library, Medline, Embase, PsycINFO, ClinicalTrials.gov, and ICTRP from inception to April 30, 2023. Randomised controlled trials that reported the effect of interventions (education, training or behavioural) to promote physical activity (either self-reported or objective) in people aged 18-60 years were included. Two independent reviewers conducted summary data extraction and quality assessment. Pairwise random-effects, Frequentist network meta-analyses, and subgroup analysis were used to obtain pooled effects.

A total of 52 trials were included in this systematic review. Compared to control group, the physical activity interventions demonstrated statistically significant effects on objectively measured physical activity (SMD 0.77, 95 % CI 0.27-1.27), self-reported physical activity (SMD 0.88, 95 % CI 0.40-1.35), and overall physical activity (SMD 0.82, 95 % CI 0.48-1.16); a statistically and clinically meaningful reduction on glycated haemoglobin A1c (HbA1c) was also identified (MD -0.50 %, 95 % CI -0.66, -0.35). In terms of intervention types, education interventions exerted the largest effect on objectively measured physical activity; however, psychological interventions had the largest effects on overall physical activity compared to other intervention types. Four behaviour change techniques were related to statistically significant reduction in HbA1c: goal setting (outcome), information about health consequences, demonstration of the behaviour, and prompts/cues. Subgroup analysis showed that delivery mode, intervention setting, and facilitator were associated with statistically significant effect on physical activity and HbA1c.

Psychologically modelled education incorporating behaviour change techniques may be the most beneficial way to promote physical activity and glycaemic control in working-age adults with type 2 diabetes. Delivery mode, intervention setting, and facilitator type should be considered when designing interventions for improving physical activity level in working-age people with type 2 diabetes.

To analyze the factors affecting stigma and quality of life in hemiplegic stroke patients following suicide attempts in nursing homes and to provide a theoretical basis for developing interventions in clinical care. General demographic information, the Stigma Scale for Chronic Illness (SSCI), and the Quality of Life Scale (SF-36) were used to investigate 259 patients with hemiplegia after stroke following nursing home suicide from January to April 2024. Univariate statistical analyses were performed to assess the impact of potential determinants on quality of life. Multiple regression models and stratified analyses with smoothed curve fitting were used for further evaluation. Multiple regression modeling showed that the factors influencing the quality of life in hemiplegic stroke patients following suicide attempts in nursing homes were stigma, Age, marital status, education, type of occupation, monthly household income, and duration of illness. The level of quality of life before unadjusted variables was strongly associated with high school and college education (β = 11.9, 95% CI: 8.2-15.6; P < 0.001), (β = 13.1, 95% CI: 9.2 -16.9; P < 0.001). After adjusting for confounders such as marital status (Married, Unmarried), Age (< 30, 30-40, 40-50, > 50) (β = 8.1, 95% CI: 4 .6-11.6; P < 0.0001). (β = 9.5, 95% CI: 6.0-13.1;P < 0.0001), the results were not significantly different. Curve fitting revealed threshold nonlinear associations between intrinsic and extrinsic stigma and quality of life, with quality of life decreasing as stigma increased. Conclusion Stigma is negatively correlated with the level of quality of life in hemiplegic stroke patients following suicide attempts in nursing homes. Different demographic profiles moderated patients' quality of life levels, and effective psychological intervention strategies should be used to improve patients' quality of life.

We designed and implemented a patient-centered, data-driven, holistic care model with evaluation of its impacts on clinical outcomes in patients with young-onset type 2 diabetes (T2D) for which there is a lack of evidence-based practice guidelines.

In this 3-year Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomized Controlled Trial, we evaluate the effects of a multicomponent care model integrating use of information and communication technology (Joint Asia Diabetes Evaluation (JADE) platform), biogenetic markers and patient-reported outcome measures in patients with T2D diagnosed at ≤40 years of age and aged ≤50 years. The JADE-PRISM group received 1 year of specialist-led team-based management using treatment algorithms guided by biogenetic markers (genome-wide single-nucleotide polymorphism arrays, exome-sequencing of 34 monogenic diabetes genes, C-peptide, autoantibodies) to achieve multiple treatment goals (glycated hemoglobin (HbA1c) <6.2%, blood pressure <120/75 mm Hg, low-density lipoprotein-cholesterol <1.2 mmol/L, waist circumference <80 cm (women) or <85 cm (men)) in a diabetes center setting versus usual care (JADE-only). The primary outcome is incidence of all diabetes-related complications.

In 2020-2021, 884 patients (56.6% men, median (IQR) diabetes duration: 7 (3-12) years, current/ex-smokers: 32.5%, body mass index: 28.40±5.77 kg/m2, HbA1c: 7.52%±1.66%, insulin-treated: 27.7%) were assigned to JADE-only (n=443) or JADE-PRISM group (n=441). The profiles of the whole group included positive family history (74.7%), general obesity (51.4%), central obesity (79.2%), hypertension (66.7%), dyslipidemia (76.4%), albuminuria (35.4%), estimated glomerular filtration rate <60 mL/min/1.73 m2 (4.0%), retinopathy (13.8%), atherosclerotic cardiovascular disease (5.2%), cancer (3.1%), emotional distress (26%-38%) and suboptimal adherence (54%) with 5-item EuroQol for Quality of Life index of 0.88 (0.87-0.96). Overall, 13.7% attained ≥3 metabolic targets defined in secondary outcomes. In the JADE-PRISM group, 4.5% had pathogenic/likely pathogenic variants of monogenic diabetes genes; 5% had autoantibodies and 8.4% had fasting C-peptide <0.2 nmol/L. Other significant events included low/large birth weight (33.4%), childhood obesity (50.7%), mental illness (10.3%) and previous suicide attempts (3.6%). Among the women, 17.3% had polycystic ovary syndrome, 44.8% required insulin treatment during pregnancy and 17.3% experienced adverse pregnancy outcomes.

Young-onset diabetes is characterized by complex etiologies with comorbidities including mental illness and lifecourse events.

NCT04049149.

Over the past 20 years, the incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have increased, particularly in racial and ethnic minorities. Despite the rise in T2DM in children and adolescents, the pathophysiology and progression of disease in this population are not clearly understood. Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM. Furthermore, the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients, mostly due to the challenges of implementing clinical trials. A better understanding of the mechanisms underlying the de-velopment and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies. This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.

In high-income countries, rates of atherosclerotic complications in type 2 diabetes have declined markedly over time due to better management of traditional risk factors including lipids, blood pressure, and glycemia levels. Population-wide reductions in smoking have also helped lower atherosclerotic complications and so reduce premature mortality in type 2 diabetes. However, as excess adiposity is a stronger driver for heart failure (HF), and obesity levels have remained largely unchanged, HF risks have not declined as much and may even be rising in the increasing number of people developing type 2 diabetes at younger ages. Excess weight is also an underrecognized risk factor for chronic kidney disease (CKD). Based on evidence from a range of sources, we explain how excess adiposity must be influencing most risks well before diabetes develops, particularly in younger-onset diabetes, which is linked to greater excess adiposity. We also review potential mechanisms linking excess adiposity to HF and CKD and speculate on how some of the responsible pathways-e.g., hemodynamic, cellular overnutrition, and inflammatory-could be favorably influenced by intentional weight loss (via lifestyle or drugs). On the basis of available evidence, we suggest that the cardiorenal outcome benefits seen with sodium-glucose cotransporter 2 inhibitors may partially derive from their interference of some of these same pathways. We also note that many other complications common in diabetes (e.g., hepatic, joint disease, perhaps mental health) are also variably linked to excess adiposity, the aggregated exposure to which has now increased in type 2 diabetes. All such observations suggest a greater need to tackle excess adiposity earlier in type 2 diabetes.

The aim to examine the link between diabetes distress and depression in individuals with diabetes, assess the mediating role of psychological resilience in this relationship, and analyses if these relationships differ between Type 1 and Type 2 diabetes. The study utilized a cross-sectional design. A total of 181 (age 33-72 years, mean = 54.76 years, and SD = 9.05 years) individuals diagnosed with diabetes who were receiving treatment from State Specialist Hospitals in Okitipupa were selected for the study using the convenient sampling technique. The data were analysed using Pearson Multiple correlation and multi-group mediation analysis. The analyses were carried out with Smartpls and IBM/SPSS Version 28.0. The results revealed a significant positive correlation between diabetes distress and depression (r = .80, p < .05), suggesting that higher levels of diabetes distress were associated with increased depression scores. Additionally, psychological resilience partially mediated the relationship between diabetes distress and depression (b = - 0.10, p < .05), signifying that resilience played a crucial role in mitigating the impact of diabetes distress on depression. Furthermore, a multi-group analysis was conducted to explore potential differences between Type 1 and Type 2 diabetes subgroups. The relationship between diabetes distress and depression was found to be more pronounced in the Type 1 subgroup (difference = 0.345, p < .05), while the relationship between psychological resilience and depression was negatively stronger in the Type 2 subgroup (difference = - 0.404, p < .05) compared to the Type 1 subgroup. There is an intricate linkage between diabetes distress, resilience, and depression, emphasizing the differential roles of resilience in Type 1 and Type 2 diabetes. The insights gleaned from this study underscore the importance of considering the type of diabetes when designing interventions and support mechanisms for individuals with diabetes who are also suffering from depression. By advancing our understanding of these dynamics, we can strive for more effective and personalized approaches to improve the overall well-being of those living with diabetes.

Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes.

A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration.

A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4).

Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.

To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes.

During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher's exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further.

The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=-1.118, p=0.019, "have hypoglycemic" as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, "have diet intervention" as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=-0.257, p<0.001) were significant negative correlators.

More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.

The benefits of regular physical activity are related to delaying and reversing the onset of ageing and age-related disorders, including cardiomyopathy, neurodegenerative diseases, cancer, obesity, diabetes, and fatty liver diseases. However, the molecular mechanisms of the benefits of exercise or physical activity on ageing and age-related disorders remain poorly understood. Mitochondrial dysfunction is implicated in the pathogenesis of ageing and age-related metabolic diseases. Mitochondrial health is an important mediator of cellular function. Therefore, exercise alleviates metabolic diseases in individuals with advancing ageing and age-related diseases by the remarkable promotion of mitochondrial biogenesis and function. Exerkines are identified as signaling moieties released in response to exercise. Exerkines released by exercise have potential roles in improving mitochondrial dysfunction in response to age-related disorders. This review comprehensive summarizes the benefits of exercise in metabolic diseases, linking mitochondrial dysfunction to the onset of age-related diseases. Using relevant examples utilizing this approach, the possibility of designing therapeutic interventions based on these molecular mechanisms is addressed.

To examine the associations between age at type 2 diabetes diagnosis and the relative and absolute risk of all-cause and cause-specific mortality in England.

In this cohort study using primary care data from the Clinical Practice Research Datalink, we identified 108,061 individuals with newly diagnosed type 2 diabetes (16-50 years of age), matched to 829,946 individuals without type 2 diabetes. We estimated all-cause and cause-specific mortality (cancer, cardiorenal, other [noncancer or cardiorenal]) by age at diagnosis, using competing-risk survival analyses adjusted for key confounders.

Comparing individuals with versus without type 2 diabetes, the relative risk of death decreased with an older age at diagnosis: the hazard ratio for all-cause mortality was 4.32 (95% CI 3.35-5.58) in individuals diagnosed at ages 16-27 years compared with 1.53 (95% CI 1.46-1.60) at ages 48-50 years. Smaller relative risks by increasing age at diagnosis were also observed for cancer, cardiorenal, and noncancer or cardiorenal death. Irrespective of age at diagnosis, the 10-year absolute risk of all-cause and cause-specific mortality were higher in individuals with type 2 diabetes; yet, the absolute differences were small.

Although the relative risk of death in individuals with versus without type 2 was higher at younger ages, the 10-year absolute risk of all investigated causes of death was small and similar in the two groups. Further multidecade studies could help estimate the long-term risk of complications and death in individuals with early-onset type 2 diabetes.

Type 2 diabetes diagnosed in childhood or early adulthood is termed early-onset type 2 diabetes. Cases of early-onset type 2 diabetes are increasing rapidly globally, alongside rising obesity. Compared with a diagnosis later in life, an earlier-onset diagnosis carries an unexplained excess risk of microvascular complications, adverse cardiovascular outcomes, and earlier death. Women with early-onset type 2 diabetes also have a higher risk of adverse pregnancy outcomes. The high burden of complications renders individuals with early-onset type 2 diabetes at future risk of multimorbidity and interventions to reverse these concerning trends should be a priority. Within the early-onset cohort, disease pathophysiology and interventions have been better studied in paediatric-onset (<19 years) type 2 diabetes compared to adults; however, young adults aged 19-39 years (a larger number proportionally) are not well characterised and are also invisible in the current evidence base supporting management, which is derived from trials in later-onset type 2 diabetes. Young adults with type 2 diabetes face challenges in self-management that older individuals are less likely to experience (being in education or of working age, higher diabetes distress, and possible obesity-related stigma and diabetes-related stigma). There is a major research gap as to the optimal strategies to deploy in managing type 2 diabetes in adolescents and young adults, given that current models of care appear to not work as well in this age group. In the face of manifold risk factors (obesity, female sex, social deprivation, non-White European ethnicity, and genetic risk factors) prevention strategies with tailored lifestyle interventions, where needed, are likely to have greater success, but more evidence is needed. In this Review, we draw on evidence from both adolescents and young adults to provide a contemporary update on the current insights and emerging trends in early-onset type 2 diabetes.