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SAN FRANCISCO – Young people who had been diagnosed with type 2 diabetes in their early teens had an "alarming" rate of diabetes-related complications at age 20 as part of new research.
In addition, among more than 500 young people participating in the TODAY-2 study (Results of the Longitudinal Study of Young People with Type 2 Diabetes), five died from a variety of causes, most of them diabetes-related. 7.5 years after their diagnosis.
"Cardiovascular risk factors are widespread in the population, target organ damage is evident, and serious cardiovascular events occur at an unexpected rate for age. [around mid-20s], "Philip S. Zeitler, MD, PhD, professor of pediatrics-endocrinology, University of Colorado School of Medicine, Aurora, principal investigator of TODAY studies, has completed a conference press held here at the American Diabetes Association (ADA) in 2019, scientific sessions.
In addition, a number of girls subsequently became pregnant – complications of pregnancy were unusually high, as well as neonatal morbidity, compared to baseline rates for girls of the same age in the general population.
"The bottom line," said Zeitler Medscape Medical News, "It's because a lot of these kids are following a very fast pace, both in terms of losing glycemic control and developing complications."
"So, contrary to the usual pediatric approach that is" Well, wait and do not give extra drugs "… I think we have to recognize that in fact, in these young children, we We probably need an even more aggressive management than many adults with type 2 diabetes. "
"They have a more aggressive illness and they are going to live with the burden of cardiovascular disease, hopefully, for 50 years, so I think the message to remember is that we should not hesitate to treat these children aggressively. "
Moderator of the press conference, Alvin C. Powers, MD, Vanderbilt University Medical Center in Nashville, Tenn., Agreed that the findings are extremely painful.
Nobody would have expected these rates of complications of sight, heart, nerves, kidneys and pregnancy in a relatively short period of diabetes, he said. Medscape Medical News.
"It's very worrying for their health in the next 10 or 15 years," he said, "because we do not have good therapy for that and we do not do it." [quite] know what to do. "
The five deaths were due to myocardial infarction, kidney failure, sepsis, postoperative cardiac arrest and overdose, said Zeitler. And just the week before, one of the study participants at their center who was barely 26 years old needed a triple bypbad of the heart.
"Taken together," he summed up, "these rates illustrate the serious personal and public health problems as these young adults enter what should be the most productive period of their lives."
It is certain that the evolution of type 2 diabetes diagnosed in young people is different from that diagnosed in adults. "Urgent research is needed to better understand the reasons for the more serious trajectory of type 2 diabetes in young people," he said.
Complications of the heart, kidneys, eyes, nerves and pregnancy
Zeitler explained that the initial TODAY study included 699 adolescents aged 10 to 17 years (average age 14) recently diagnosed with type 2 diabetes in 15 centers.
Participants were from various racial and ethnic backgrounds – Hispanic (40%), Black (33%), White (21%) or other race / ethnicity (7%) – and two-thirds were women.
The results of TODAY, published in the New England Journal of Medicine in 2012, showed that type 2 diabetes was "more aggressive in children than in adults" and that participants had a rapid loss of beta cell function.
By the end of the TODAY study in 2011, 572 participants aged 18 years on average participated in Phase 1 of the TODAY-2 follow-up study at the same study sites, which has lasted 3 years.
Then, 517 participants averaging 21 years of age in 2014 participated in Phase 2 of the TODAY-2 study, during which they received care in the community.
Today, in 2019, participants are on average 25 years old and have type 2 diabetes for an average of 7.5 years and, in some cases, up to 12 years.
On average, at the beginning of the TODAY study, participants had a body mbad index (BMI) of 34.9 kg / m2 and an HbA1 C 6.0%.
At the beginning of TODAY-2, they had a BMI of 36.3 kg / m2 and an HbA1 C 9.3%.
Complication rates increased steadily in the years following the initial diagnosis of type 2 diabetes that occurred in young people.
During the 12 years of follow-up, the cumulative incidence of LDL hypercholesterolemia increased from 3% to 26%, and the cumulative incidence of hypertension rose from 20% to 55%. %.
Echocardiography performed at the end of the TODAY study and again in TODAY-2 detected abnormal findings in 30% of participants.
During follow-up, 38 cardiovascular events evaluated – arrhythmias, myocardial infarction, heart failure, left ventricular dysfunction, deep vein thrombosis, vascular insufficiency, stroke or transient ischemic attacks – in 19 patients, for a rate of 6.2 events cardiovascular / 1000 patients / year.
The prevalence of abnormal excretion of albumin increased from 8% to 42% at the beginning of the study and the prevalence of hyperfiltration increased from 12% to 55%.
Four renal events were evaluated: two patients had both chronic renal disease and end stage renal failure, corresponding to 0.7 renal events / 1000 patients / year.
And of the 370 participants who had eye pictures taken in 2011 and 2018, there was a "substantial" progression of diabetic retinopathy.
For example, 14% of TODAY participants had mild non-proliferative retinopathy (NPDR), but about 6 years later, 22% of TODAY-2 participants had mild NPDR.
None of the TODAY patients had macular edema, but 4% of TODAY-2 patients developed it.
There were 142 ocular events badessed – NPDR, proliferative diabetic retinopathy, macular edema, cataracts and glaucoma – corresponding to 15.5 ocular events / 1000 patients / year.
Similarly, there were 14 neuropathic events in 12 patients, or 2.3 neuropathic events / 1000 patient-years, Zeitler said.
The prevalence of diabetic neuropathy, determined by an abnormal monofilament test, increased by 8% at 12 years.
Diabetic retinopathy and neuropathy were more common in participants who did not maintain glycemic control.
Pregnancy, maternal and neonatal disorders
From 2005 to 2019, there were 236 pregnancies with known outcomes among approximately 350 girls and young women.
11.9% of these pregnancies resulted in miscarriage (compared to a national rate of 10% to 15%), 3.8% of babies were stillborn (compared to 0.4%) and 23.7% of babies were premature (compared to 6.9%). 9.9%).
The birth weight of the babies was also asymmetrical: 15.9% of them had a very low birth weight (against 8.3%) and, conversely, 18.9% had a macrosomia. birth weight> 4000 g versus 8.2% in the general population.
And 28.7% of babies had neonatal hypoglycemia (2.1%), 14.9% were in respiratory distress (7%) and 8.5% had a cardiac abnormality compared to 1% in the general population .
In addition, 35.6% of girls were hospitalized for maternal complications, compared to 14% in the general population: 18.1% developed preeclampsia and 37.5% had maternal hypertension.
"The very high rates of pregnancy complications among mothers and children are worrisome," Zeigler said.
He added that today's researchers will follow the offspring of these girls to take stock of their progress.
The current study has informed new guidelines for the management of patients with type 2 diabetes in young people, who recognize that the disease in young people is different; these were published by ADA in December 2018, he concluded.
ADA 2019 Science Sessions. June 8, 2019.
Today's studies are funded by the National Institutes of Health.
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