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. 2014 Nov;5(6):234–244. doi: 10.1177/2040622314548679

Early onset type 2 diabetes: risk factors, clinical impact and management

Emma Wilmot 1,✉, Iskandar Idris 2
PMCID: PMC4205573  PMID: 25364491

Abstract

Early onset type 2 diabetes mellitus (T2DM) is increasingly prevalent with a significant impact on the individual, healthcare service delivery and planning. The individuals are likely to be obese, lead a sedentary lifestyle, have a strong family history of T2DM, be of black and minority ethnic (BME) origin and come from a less affluent socioeconomic group. They have a heightened risk of developing microvascular and macrovascular complications, often at an earlier stage and with greater frequency than seen in type 1 diabetes. As such, early and aggressive risk factor management is warranted. Early onset T2DM is complex and impacts on service delivery with a need for multidisciplinary care of complications and comorbidities’, in addition to adequate educational and psychological support. This review on the impact of early onset T2DM provides the latest insights into this emerging epidemic.

Keywords: management, risk factors, type 2 diabetes

Introduction

In the past three decades there has been a progressive increase in the prevalence of early onset type 2 diabetes mellitus (T2DM) [González et al. 2009; Mokdad et al. 2000]. T2DM was once considered a disease of older adults but the age of diagnosis is falling and it is now increasingly diagnosed in adolescents and young adults to the extent that T2DM will soon become the predominant form of diabetes in some ethnic groups [Alberti et al. 2004; Braun et al. 1996; Dabelea et al. 2009; Drake et al. 2002; Kitagawa et al. 1998; Koopman et al. 2005; Sharp et al. 2008]. An inverse relationship exists between body mass index (BMI) and the age of onset of T2DM [Hillier and Pedula, 2001] with severe weight gain <40 years associated with a higher risk of T2DM [Schienkiewitz et al. 2006].

The impact of early onset T2DM is extensive. The individuals are likely to be obese, have a multigenerational family history of T2DM, lead a sedentary lifestyle, be of black or minority ethnic (BME) origin and come from a socially deprived group [Feltbower et al. 2003; Haines et al. 2007]. They have a heightened risk of the premature development of microvascular and macrovascular complications, in addition to psychological morbidity, during their working life [Dean et al. 2002; Eppens et al. 2006]. The impact on service delivery is also substantial with a need to recognize and cater for the complexity and specific needs of individuals with early onset T2DM, in addition to planning for the expansion of services such as specialist diabetes antenatal services. From a societal perspective, the costs are huge, with estimates suggesting that the direct and indirect cost of T2DM for 2010–2011 in the UK was approximately £21 billion. This is estimated to rise in real terms to £35.6 billion in 2035–2036 [Hex et al. 2012]. This paper aims to explore the impact of early onset T2DM for the individual in terms of complications and health service planning.

Definition

Available data tend to separate early onset T2DM into the paediatric (<19 years) and adult (>19 years) populations. However, there is a continuum of risk associated with an earlier diagnosis and this distinction, while useful for service provision, fails to recognize the potential for poorer outcomes in patients diagnosed in their third and fourth decades of life. For instance a diagnosis of T2DM <45 years is associated with a 14-fold increase in the risk of a myocardial infarct [hazard ratio (HR) 14.0, 95% confidence interval (CI) 6.2–31.4], substantially greater than the 4-fold increase (HR 3.7, p < 0.001) in those diagnosed >45 years [Hillier and Pedula, 2003]. Furthermore, the cutoff of 45 years is important because this captures women with T2DM who are of child bearing age, a particularly high risk state which needs to be considered in both management strategies and service delivery. Recognizing that there is a paucity of data from the 19–45 year-old age group, this review presents available data from across the age ranges, defining early onset T2DM as <45 years.

Epidemiology

Many Western countries have witnessed an increase in the prevalence of early onset T2DM. New York experienced a 10-fold increase in T2DM in children between 1990 and 2000 [Grinstein et al. 2003]. In the UK there was an eightfold increase in prescriptions for oral glucose lowering therapy between 1998 and 2005 [Hsia et al. 2009]. The prevalence of T2DM in this study was estimated at 1.9/100,000, almost 10 times higher than the first UK report of T2DM in adolescents in 2000 of 0.21/100,000 [Ehtisham et al. 2004]. Adult diabetes specialist services in the UK have witnessed similar increases in early onset, with T2DM accounting for 5% of the diabetes population <30 years in 2003, increasing to 12% by 2006 [Feltbower et al. 2003; Harron et al. 2011] and extending to 24% of the diabetes population <40 years [Song et al. 2009]. In Japan the incidence of childhood onset T2DM doubled between the late 80s and the early 90s, such that a child presenting with new onset diabetes in Japan is now statistically more likely to have T2DM than T1DM [Kitagawa et al. 1998]. Early onset T2DM has been reported in many countries across the world including Australia, Canada, China, India, Japan, Mexico and Australia [Braun et al. 1996; Dabelea et al. 2009; Dean et al. 2002; Kitagawa et al. 1998].

Pathophysiology

The pathophysiology of T2DM is complex, with an alteration in the balance between insulin sensitivity and insulin secretion as the most important determinant in the development of T2DM. T2DM results from the gradual fall in β cell function on a background of insulin resistance. Adolescents with glucose dysregulation are likely to have more impairment in insulin secretion compared with reduced insulin sensitivity [Bacha et al. 2010]. Studies of insulin secretion and glucose disposal in adolescents with glucose dysregulation have identified that, in impaired fasting glycaemia (IFG), the insulin stimulated glucose disposal is normal but first and second phase insulin secretion are approximately 50% and 30% lower, respectively. In impaired glucose tolerance (IGT) the first phase insulin secretion is approximately 40% lower while second phase insulin secretion is preserved. If IFG and IGT coexist, there is impairment in both phases – approximately 55% lower first phase insulin and 30% lower second phase insulin secretion. In T2DM, glucose disposal is impaired by ~30%, first phase insulin by ~ 75%, and second phase insulin by ~65% compared with children with normal glucose tolerance [Bacha et al. 2010]. Further, the deterioration in β cell function in youth with T2DM is more accelerated (~15% per year) than observed in adults [Gungor et al. 2004]. As such, those who have a combination of IFG and IGT are likely to have a higher risk of progression to T2DM compared with those with either IFG or IGT in isolation.

Insulin resistance is largely driven by obesity. However, it is not the degree of obesity which matters, rather the distribution of fat. A combination of high intramyocellular lipid content, increased visceral, decreased subcutaneous and ectopic liver fat deposition is most likely to result in glucose dysregulation in both young adult and paediatric populations [D’Adamo et al. 2011].

Risk factors

The development of early onset T2DM represents a complex interplay between genetic and environmental factors. Table 1 summarizes the risk factors for developing early onset T2DM. Overall, the risk factors for T2DM in early onset are similar to those for late onset T2DM, with the additional risks factors of female sex and puberty, which contributes to insulin resistance.

Table 1.

Risk factors for type 2 diabetes mellitus in youth.

Modifiable

  • Obesity

  • Low physical activity

  • High sedentary behaviour

  • Socioeconomic status

Nonmodifiable

  • Ethnicity (Pima Indian, Hispanic, Asian and Afro-Caribbean)

  • Family history of type 2 diabetes mellitus

  • Puberty

  • Low birth weight

  • Exposure to diabetes mellitus in the uterus

  • Female sex

  • Previous gestational diabetes
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Obesity

The vast majority of those with early onset T2DM are obese (80–92%) compared with only 56% of older adults [Hsia et al. 2009; Shield et al. 2009] with an inverse linear relationship between BMI and the age at diagnosis of T2DM [Hillier and Perdula, 2001].

Family history

Genetic predisposition plays an important part in the risk of developing T2DM. Some 84% of UK adolescents with T2DM have a family history of T2DM while 56–71% have an affected parent or sibling [Haines et al. 2007; Shield et al. 2009]. While it is likely that a genetic predisposition increases the risk of early onset T2DM, families often share a similar environment.

Ethnicity

Internationally, Japanese, Hispanics and Native Americans have the highest risks of developing T2DM in childhood [Chan et al. 1993; Dabelea et al. 2009; Lawrence et al. 2009; Liu et al. 2009]. In the UK, 43–56% are from a black or minority ethnic origin with prevalence rates of 3.9/100,000 in black and 1.25/100,000 in South Asians compared with the much lower rate of 0.35/100,000 in white children [Haines et al. 2007].

Low physical activity

Physical inactivity is a key factor in the obesity and diabetes epidemic in younger people. Clustered metabolic risk (including insulin sensitivity) increases in a dose–response manner with decreasing physical activity in children aged 9–15 years [Andersen et al. 2006; Ekelund et al. 2007]. This steep decline in physical activity in adolescence is associated with increased weight gain, a key factor in the development of glucose dysregulation in children [Kimm et al. 2005; Weiss et al. 2005].

Clinical outcomes

We and others have shown that patients with young onset T2DM have a more adverse cardiovascular risk profile compared with individuals with later onset diabetes [Gunathilake et al. 2010; Song et al. 2009]. In addition, patients with young onset T2DM have been shown to have a much higher risk of microvascular complications than age-matched type 1 diabetes controls, despite good glycaemic control [Hillier and Pedula, 2003; Pavkov et al. 2006; Wong et al. 2008]. Lifetime exposure to hyperglycaemia combined with the presence of multiple cardiovascular risk factors in young onset T2DM results in a heightened risk of vascular complications. This is likely to reduce quality of life, increase morbidity and premature mortality. This section considers the impact in terms of microvascular and macrovascular complications.

Microvascular complications

Nephropathy

Nephropathy in diabetes is a concern not only because it can result in end stage renal failure but also because it is associated with cardiovascular disease. Renal disease is the most frequently described complication in early onset T2DM. In the paediatric and adult population, microalbuminuria is often present at diagnosis (up to 25%), increasing to 28–42% at 5 years after diagnosis and 60% 10 years after diagnosis [Benhalima et al. 2011; Eppens et al. 2006]. Those diagnosed <18 years-old have higher rates of microalbuminuria and hypertension than seen in T1DM, despite a shorter duration of diabetes and lower HbA1c supporting the hypothesis that early onset T2DM is a more aggressive form of diabetes [Eppens et al. 2006].

End stage renal failure starts to manifest approximately 10 years after the diagnosis of early onset T2DM [Dart et al. 2014]. Pima Indians, diagnosed with T2DM <20 years, have a five-fold increase in the risk of developing end stage renal failure in middle age compared with T1DM while Japanese data report a significantly higher cumulative incidence of nephropathy in younger adults diagnosed with T2DM under the age of 30 years compared with type 1 diabetes mellitus (T1DM) (44 versus 20%, p < 0.0001) [Pavkov et al. 2006; Yokoyama et al. 2000]. A large Canadian dataset (<18 years-old) more recently reported a 4-fold increased risk of renal failure compared with T1DM counterparts and a 23-fold increase compared with control subjects [Dart et al. 2012]. After 20 years of follow up, endstage renal failure was present in up to 50% of those diagnosed with T2DM in adolescence, substantially worse than in the T1DM group [Dart et al. 2012]. These data suggest that there are inherent differences in the renal risk between T2DM and T1DM in youth. Interestingly, systolic hypertension was not a risk factor in the Dart cohort, while renin angiotensin aldosterone system (RAAS) pathway inhibition was (15.8 fold increased risk of renal failure) [Dart et al. 2012]. While this may reflect confounding from disease severity, it is important to reflect on the fact that, despite the benefits seen in the older population with T2DM, we do not yet have evidence of benefit from RAAS blockade in the younger population.

Neuropathy

A range of small cross-sectional studies have reported high rates (up to 57%) of neuropathy in paediatric T2DM populations [Dart et al. 2014; Karabouta et al. 2008; Paisey et al. 2009]. The definition of neuropathy and the testing methods employed often varies. For instance, comparing a sample of UK adolescents with T2DM (n = 7) and T1DM (n = 120), 57% of those with T2DM had evidence of peripheral neuropathy when assessed using light touch/vibration sense whereas none of those with T1DM had evidence of peripheral neuropathy [Karabouta et al. 2008]. This compares with a large study of adolescents with T2DM (n = 342) and T1DM (n = 1011) which found peripheral neuropathy (diagnosis based on disease coding) in 7.6% of the T2DM group and 5% of the T1DM group [Dart et al. 2014]. Despite these limitations, a consistent message emerging from these studies is that neuropathy develops earlier in T2DM than T1DM. This aggressive course can result in foot ulceration as early as 2 years after diagnosis and amputation after 10 years [Dart et al. 2014; Paisey et al. 2009].

Retinopathy

Reported rates of retinopathy in early onset T2DM varies considerably in the literature depending on the study methods used (4–40%) [Eppens et al. 2006; Krakoff et al. 2003; Okudaira et al. 2000; Pavkov et al. 2006; Scott et al. 2006; Yokoyama et al. 1998; TODAY Study Group, 2013]. Early onset T2DM can be associated with the premature development of retinopathy which is more severe than seen in T1DM. A population-based cohort study in Sweden found similar rates of retinopathy between groups but the incidence of severe retinopathy was significantly higher in younger adults aged 15–34 years with T2DM compared with T1DM both at diagnosis and follow up 10 years on [Henricsson et al. 2003]. Detailed retinal assessment of adolescents with T1DM and T2DM has identified subclinical structural and functional retinal abnormalities which are more pronounced in the T2DM group compared with the T1DM group, despite a shorter duration of T2DM (2.1 versus 5.7 years) [Bronson-Castain et al. 2012].

Cardiovascular morbidity and mortality

Cardiovascular risk markers are often present in early onset T2DM. At diagnosis, 26% of adolescents have hypertension, increasing to 50% by the fourth decade [Benhalima et al. 2011; TODAY Study Group et al. 2012]. Research has found that 80% of adolescents have a low high-density lipoprotein level and 10% have elevated triglycerides at diagnosis, a finding which tends to progress rather than improve with follow up [Bell et al. 2009; Eppens et al. 2006; TODAY Study Group et al. 2012; Upchurch et al. 2003; Zdravkovic et al. 2004]. By the fourth decade, those with early onset T2DM in the UK (mean age 34 years) have a cardiovascular risk profile (overweight, hyperlipidaemia, hypertension) similar to that of an older adult with T2DM (mean age 67 years) [Gunathilake et al. 2010]. Surrogate markers also identify heightened risk: higher aortic pulse wave velocity, aortic stiffness and greater carotid-intima-media thickness in adolescence [Gungor et al. 2005; Wadwa et al. 2010; Urbina et al. 2009] in addition to the presence of diastolic dysfunction by the fourth decade [Wilmot et al. 2014]. There is concern that this lifetime exposure to risk will culminate in adverse cardiovascular outcomes during working lives. Despite this, only 1 in 5 patients with T2DM in paediatric clinics have blood pressure recorded, suggesting that physicians may underestimate the risk in early onset T2DM. This is further reflected in the consistent undertreatment of both hypertension and hyperlipidaemia in both paediatric and young adult groups [Benhalima et al. 2011; Shield et al. 2009].

Because early onset T2DM is a relatively new phenomenon, having only been recognized in the past few decades, cardiovascular outcome follow-up data are limited. A 9-year follow up of 69 First Nation Canadians adolescents with T2DM demonstrated a striking mortality rate of 9%. Of the remaining survivors, 35% developed microalbuminuria, 45% had hypertension and 6% were on dialysis [Dean et al. 2002]. We also know that those diagnosed with T2DM <45 years have a 14-fold increased risk of a myocardial infarct compared with a 4-fold increase in those diagnosed >45 years [Hillier and Pedula, 2003]. A modelling study has estimated that T2DM diagnoses between 15–24 years will be associated with a 15-year reduction in life expectancy and, for some, the development of severe chronic complications in their fifth decade [Rhodes et al. 2012].

Nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is an important marker of insulin resistance. It is the most common liver abnormality seen in children and is present in approximately 50% of children with T2DM [Bloomgarden, 2007]. A 20-year follow-up study of adolescents with NAFLD (without diabetes) reported that 6% died or required a liver transplant with a standardized morality ratio of 13.6 [Feldstein et al. 2009]. This would suggest that the combination of T2DM and NAFLD developing early in life is likely to lead to substantial morbidity and mortality.

T2DM and pregnancy

There has been a substantial increase in the number of women with early onset T2DM attending maternity services. A third of the women in the UK Confidential Enquiry into Maternal and Child Health (CEMACH) report had T2DM [CEMACH, 2007]. T2DM in pregnancy has a significant impact on the mother, the fetus and service provision. It is associated with a number of risks for both the mother and fetus, with outcomes for women with T2DM are just as poor as for women with T1DM. These include miscarriage, preterm labour, macrosomia, birth injury, neonatal hypoglycaemia and stillbirth in addition to a 2-fold increase in the rate of congenital malformations and a 3-fold increase in the risk of perinatal mortality [CEMACH, 2007]. These risks are likely to be even higher in adolescents with T2DM. A group of Canadian adolescents with T2DM were followed up for 10 years and of those who became pregnant, 38% experienced pregnancy loss [Dean et al. 2002]. These risks associated with diabetes and pregnancy can be minimized through meticulous glycaemic control (HbA1c <6.1%), high dose folic acid (5 mg a day) combined with close monitoring of the mother and fetus [NICE, 2008]. Unfortunately women with T2DM are less likely to have prepregnancy counselling, preconception folic acid or a test of glycaemic control in the 6 months before conception compared with women with T1DM [CEMACH, 2007]. The increasing number of women of child bearing age who have T2DM has a substantial impact on service planning and delivery. They represent complex cases that require an intensive multidisciplinary approach both in terms of preconception and antenatal care to minimize risk.

Psychological aspects

The psychological burden on youth with T2DM is great. They not only need to strive for excellent glucose control and weight loss, but also the need to take multiple medications and cope with complications and comorbidities at an early stage in life. The combination of increased body weight, body dissatisfaction, previous dieting and a history of depression can result in binge eating disorders [Pinhas-Hamiel et al. 2013]. Two-thirds report severe diabetes-related distress while more than a quarter have impaired general emotional well-being [Browne et al. 2013]. Many live in fear of disclosure of their condition and have higher rates of depression and report lower quality of life than youth with T1DM [Brouwer et al. 2012; Hood et al. 2014]. The above issues impact on self management and will require further research to enable a better understanding of how we best support younger people living with T2DM.

Management

Glucose lowering therapies

The majority of patients with early onset T2DM <45 years will have access to the wide array of glucose lowering therapies currently approved for adult use, including gliptins and glucagon-like peptide-1 (GLP-1) analogues. Such agents would, in theory, benefit those with early onset T2DM, who tend to have a higher BMI at diagnosis than older adults. However, the evidence base underpinning these agents is often from an older adult population and available data do not describe the clinical response in younger adults.

Drug licensing restrictions apply to the paediatric population and warrant special consideration. Currently, metformin and insulin are the only drugs approved for use in the paediatric population with T2DM. Metformin inhibits gluconeogenesis and promotes peripheral glucose uptake, improving glucose sensitivity. Few trials have assessed traditional oral hypoglycaemic agents in early onset T2DM. In 2002 a multi-centre double blind trial concluded that metformin was safe to use in 82 subjects aged 10–16 years for up to 16 weeks. This period was associated with a reduction in HbA1c of 1.2% and a 3.6 mmol/l reduction in fasting glucose compared with the placebo arm [Jones et al. 2002]. Glimepiride, a sulphonylurea, promotes insulin secretion. In 2007 a single blind multi-national study reported that glimepiride reduced HbA1c similarly to metformin in 263 young people with T2DM (mean age 13.8 years). However, the use of glimepiride was associated with a 1.97 kg weight gain compared with only 0.55 kg in the metformin group. Safety profiles of both drugs were comparable over the 26-week follow-up period [Gottschalk et al. 2007].

The TODAY trial follows on from these preliminary trials and is the largest therapeutic trial to be conducted in a large cohort of adolescents with T2DM [TODAY Study Group et al. 2012]. In this 4-year follow-up randomized controlled trial, those recently diagnosed with T2DM were randomly assigned to either metformin alone, metformin and a lifestyle intervention, or metformin plus rosiglitazone. The addition of rosiglitazone but not the lifestyle intervention was superior to metformin alone [TODAY Study Group et al. 2012] (Table 2). The metformin treatment failure rate was higher than is seen in older adults with T2DM and suggests that younger adults with T2DM are likely to require more aggressive polypharmacy early in the course of their disease [TODAY Study Group et al. 2012]. This trial also suggests that the benefits of lifestyle interventions in adolescents with T2DM may be limited, but this requires more detailed exploration.

Table 2.

Results from the TODAY trial [TODAY Study Group et al. 2012].

Intervention Failure rate
Metformin alone 51.7%
Metformin + lifestyle 46.6%
Metformin + rosiglitazone 38.6%
Pairwise test p value
Metformin + lifestyle versus metformin 0.015
Metformin versus metformin + rosiglitazone 0.006
Metformin versus metformin + lifestyle 0.17
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The study compared the efficacy of three treatment regimens (metformin 1000 mg twice daily alone, a metformin + lifestyle intervention programme focusing on weight loss through eating and activity behaviours, and metformin + rosiglitazone 4 mg twice daily) to achieve durable glycaemic control in children and adolescents with early-onset type 2 diabetes. The primary outcome was loss of glycaemic control, defined as a glycated haemoglobin level of at least 8% for 6 months or sustained metabolic decompensation requiring insulin. Results are described in the text.

Cardiovascular risk management

In terms of cardiovascular risk management, lifestyle interventions to reduce weight and increase exercise are advocated. If hyperlipidaemia or hypertension persists, then a statin or angiotensin converting enzyme inhibitor should be initiated [Rosenbloom et al. 2009]. However, there have been no pharmacotherapeutic outcome studies of such agents in early onset T2DM. This is perhaps reflected in clinical practice with the consistent under treatment of hyperlipidaemia and hypertension [Benhalima et al. 2010]. This is more so the case in the female population, perhaps due to concerns about the possibility of conception. Significantly fewer women are treated for hypertension (22% versus 43%, p < 0.01) and hypercholesterolaemia (16% versus 43%, p < 0.01) than men, despite similar rates of hypercholesterolaemia and hypertension [Benhalima et al. 2010]. Overall, early onset T2DM is an aggressive condition which will require aggressive management of blood pressure, lipids, glycaemic control and weight.

Bariatric surgery

Bariatric surgery is capable of inducing diabetes remission in adults with T2DM, in addition to considerable weight loss [Schauer et al. 2014]. Restrictive bariatric procedures include gastric banding and sleeve gastrectomy while malabsorptive procedures include gastric bypass and biliopancreatic diversion. Malabsorptive procedures are superior in achieving remission of T2DM. Guidelines for the safe and effective delivery of bariatric surgical care for adolescents do exist and bariatric surgery has been shown to reverse T2DM in some severely obese children [Al-Qahtani, 2007; Inge et al. 2009; Michalsky et al. 2011]. Although surgery might be viewed as an extreme measure, in view of the accelerated development of multiple complications in early onset T2DM, it may be an option worth considering in selected cases. Further research in this area is required.

Structured education

Self management is the cornerstone of diabetes care. In younger adults with T2DM, lack of motivation, feeling burned out and being time poor have been identified as some of the key barriers to self management. Few participate in structured diabetes education [Browne et al. 2013]. This is perhaps a reflection of the fact that existing education courses, which were designed for older adults, do not meet the specific needs of those with early onset T2DM [Browne et al. 2013]. To overcome these issues, a course written specifically for and attended by groups of younger adults with T2DM would be more appropriate [Brouwer et al. 2012]. Furthermore, it has been identified that even for those who have completed structured education courses, there is a high level of need for ongoing learning [Richards et al. 2013]. This will require the continued assessment of learning needs, follow-up education and behavioural approaches for these high risk individuals [Richards et al. 2013].

Implications for service delivery and policy

Those with early onset T2DM represent a high risk group with high needs for effective management and support. At present, many of these individuals are cared for by generalists in the community. Given the complexity, the suboptimal response to available therapies and the heightened risk of complications it could be argued that these individuals should be cared for in a multidisciplinary specialist clinic with access to specialist psychological, dietary and bariatric support. Structured education is a cost effective and acceptable way of empowering patients to optimize their self-management skills. There is a need to develop a curriculum which meets the needs of those with early onset T2DM, with specific focus on relevant topics such as preconception care, the impact of family members with T2DM, body image, self-esteem, recognizing and managing depression, etc. Follow-up education also needs to be developed and could embrace currently available technologies such as internet forums and social media.

Of course, the ideal solution would be the prevention of T2DM in young people. Although beyond the scope of this paper, tackling the obesity epidemic will require combined efforts on behalf of individuals, healthcare professionals and organizations, and government to make changes to reduce the prevalence of obesity. Policies on food marketing, exercise, structured environment, transportation, physical activity in schools and work will need to change to allow this to happen. In the meantime there is a need to identify and screen those at risk of T2DM so that intensive lifestyle interventions can delivered in an attempt to reverse, or at least prevent, weight gain and the development of T2DM [NICE, 2013].

Conclusion

Early onset T2DM is an increasingly common problem which leads to the premature development of microvascular and macrovascular complications. Although we do not yet have a full understanding of the natural history of this condition, the impact on the individual, service delivery and finances will be substantial. Those with early onset T2DM represent a high risk group with specific issues and needs. They merit an aggressive and supportive management in a multidisciplinary setting to prevent the development of significant morbidity during their most productive years.

Footnotes

Conflict of interest statement: The authors declare no conflict of interest in preparing this article.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Contributor Information

Emma Wilmot, Department of Diabetes & Endocrinology, Royal Derby Hospital, Uttoxeter Road, Derby, UK.

Iskandar Idris, Royal Derby Hospital and Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham, Nottingham, UK.

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