MDNews - San Antonio

Youth-Onset Type 2 Diabetes Is Derailing the Lives of Young Adults T Y P E 2 D I A BE T E S was once known as adult-onset diabetes because of its usual manifestation when people are in their 40s or 50s, and often after years of struggling with being overweight or obese, a poor diet, and a lack of exercise. Increasingly, however, physicians are seeing much younger patients affected by the disease. Heeding the warning signs, Dr. Lynch a nd col laborators nationw ide in iti- ated a study in 2004 ca l led TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth). The study enrolled and treated adolescents with youth-onset Type 2 diabetes until 2011. The study's comparison of metformin, rosiglitazone and lifestyle intervention yielded underwhelming results. All par- ticipants declined in pancreatic function with each passing year. At the conclusion of the study in 2011, all participants were invited to remain for an observationa l phase. It has fol- lowed 517 participants who have had the disease for an average of 12 years. At annual patient visits, information was gathered using laboratory testing, echocardiograms, vessel function test- ing and eye examinations. Researchers also collected each participant's medical histor y to chart any diabetes-related events. These data were presented at the 2019 American Diabetes Association meetings in San Francisco. The researchers found the development of diabetes-related complications in indi- viduals with youth-onset disease is often much more rapid than it is in individuals who develop the disease later in life. Now in their 20s, the TODAY participants are experiencing life-changing health consequences caused by Type 2 diabetes at the earliest stages of adulthood: + Five deaths have occurred in this young adult population. + More than 50% of participants have abnormal lipids. + More than 60% have high blood pressure. + About 40% of participants have evi- dence of early diabetic kidney disease. + Almost 50% of participants have evi- dence of diabetic retinal disease. + Up to 33% of participants demonstrate signs of early diabetic nerve disease. + Twenty-five percent of pregnancies w ith know n outcomes resu lted in miscarriage or fetal death. + Twenty-four percent of these pregnan- cies were preterm births. T he f i nd i n g s su g ge s t hea lt hca re professionals need to aggressively treat young patients battling Type 2 diabetes to minimize the damage from serious diabetes-related complications. This intensive management depends on coor- dinated care by teams of expert providers. It also requires families' commitment to continue to seek care, even if their child's disease has stabilized. Additiona lly, more medications are needed for t h is d isea se i n ch i ld ren . Until recently, metformin and insulin were the only therapies approved by the FDA for Ty pe 2 diabetes in children. Encouragingly, data from a n interna- tiona l study in which Dr. Lynch and her colleagues assisted, called Ellipse, led to FDA approval in June of a new injectable drug, liraglutide, for Type 2 diabetes in youth as young as age 10. That is a bit of good news in an oth- er w ise dif f icu lt la ndscape for t hese c h i ld r en a n d t h ei r f a m i l ie s . S t i l l , fa m i lies must cope w it h a g g ressive s y mpt om s, few med icat ion opt ion s a nd cha lleng ing complia nce. This is the hard reality on the front lines of this devastating epidemic. However, research is the key to a better tomorrow. Dr. Lynch is part of a cadre of diabetes exper ts at UT Hea lth Sa n A ntonio that is conducting visiona r y research and incorporating the latest findings into preeminent patient care. Lives will be changed as a result. Young people are our greatest resource. We will fight this scourge with a ll our might to keep it from further harming the lives of our children. William L . Henrich , MD, M ACP, a nephrologist and Professor of Medicine, has been President of UT Health San Antonio since 2009. With missions of teaching, research, healing and community engagement, UT Health San Antonio is one of the country's leading health sciences universities. Visit uthscsa.edu to learn more. n BY WILLIAM L. HENRICH, MD, MACP PRESIDENT, UT HEALTH SAN ANTONIO JANE LYNCH, MD, A PEDIATRIC ENDOCRINOLOGIST AT UT HE ALTH SAN ANTONIO, IS TRULY ON THE FRONT LINES OF SAN ANTONIO'S AL ARMING INCRE A SE OF T YPE 2 DIABE TES IN CHILDREN. SINCE 2005, MORE THAN 1,000 YOUTH UNDER THE AGE OF 18 HAVE BEEN DIAGNOSED WITH THE DISE A SE IN HER CLINIC AT THE TE X A S DIABE TES INSTITUTE ON SOUTH Z ARZ AMOR A STREE T. THE YOUNGEST WA S ONLY 5 YE ARS OLD AT THE TIME OF DIAGNOSIS. William L. Henrich, MD, MACP M D N E W S . C O M /// M D N E W S S A N A N T O N I O ■ 2 019 0 5

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