Introduction: This article will discuss youth-onset type 2 diabetes and its complications. The first part of the article will discuss what youth-onset type 2 diabetes is The second part of the article will discuss complications that occur after being diagnosed with type 2 diabetes and simple measures that can be taken to prevent type 2 diabetes

What is youth-onset type 2 diabetes?

Youth-onset type 2 diabetes is a disease that occurs in children, teenagers and young adults. Type 2 diabetes in youth takes place because of insulin resistance that is determined by a list of risk factors: genetic predisposition, excessive food consumption, race and ethnicity, intrauterine environment, and poor lifestyle. It has been discovered that insulin resistance isn’t the only factor that contributes to type 2 diabetes in youth but also β-cell dysfunction and inadequate insulin secretion, α-cell dysfunction, hyperglucagonemia and increased hepatic glucose production, lipotoxicity, inflammation, deficiencies in incretin production and action, and increased renal glucose reabsorption[1].

Symptoms that are presented to indicate Type 2 Diabetes in youth are:

    • Increased thirst
    • Increased urination
    • Blurry vision
  • Frequent urination
  • Fatigue
  • Darkened areas of skin, mostly around the neck and in the armpits and the groin.
  • Weight loss

Type 2 diabetes in kids in the UK was first diagnosed in 2000. It was presumed that all kids with glucose intolerance had type 1 diabetes but advances in genetics in the 1990s identified the difference between type 1 and type 2 diabetes in kids. Type 2 diabetes has increased rapidly over the last 20 years and its numbers are growing with approximately 41,600 kids and teenagers being diagnosed in 2021 worldwide. Children with T2DM differ from adults with T2DM with them having a more aggressive clinical approach due to difficulty in diagnosis, management and monitoring of Type 2 diabetes in children and young people.

 

 

 

 

The image is taken from Taking Control Of Your Diabetes (TCOYD)

 

What importance do alpha cells and beta cells have in Type  2 diabetes?

Alpha cells and beta cells are both important in homeostasis. They both produce hormones which are responsible for the maintenance of blood sugar levels in the body.

Alpha cells are responsible for producing the hormone glucagon that aids in increasing blood glucose levels when low in the body. The dysfunction of alpha cells in the body means that plasma glucose in the blood increases which leads to glucose toxicity and diabetes. Having high levels of plasma glucose means that cells are unable to store glucose. This unstored glucose will be travelling in the bloodstream. This condition is known as glucagonoma.

On the other hand, beta cells are responsible for insulin secretion that lowers blood glucose levels in the blood. In T2DM these beta cells will have to work harder to maintain blood glucose levels. The consequence of beta cells overworking is that they stop working. Research suggests that the overwork of beta cells could cause them to stop working properly or die[2]. The dysfunction of beta cells is believed to lead to insulin resistance. T2DM in kids is associated with greater insulin secretion and more rapid deterioration of beta cell function decline than Type 2 in adults.

Complications of type 2 diabetes:
What is hypertension?
Hypertension is the systolic blood pressure greater than 130 mmHg or diastolic pressure greater than 80 mmHg. In simple terms, it is high blood pressure in blood vessels. Based on research done in 2021[3] one of the main complications is that children and teenagers with type 2 diabetes developed hypertension(67.5%).

Hypertension in diabetes is caused by high peripheral artery resistance. This high peripheral artery resistance is caused by vascular remodelling (by stiffening the walls of blood vessels) and high body fluid which is associated with insulin resistance-induced hyperinsulinemia and hypoglycemia.

The impact of hypertension and type 2 diabetes can lead to other serious complications like cardiovascular disease or kidney disease. To treat hypertension in type 2 diabetes angiotensin receptor blockers are the most effective drugs that can be prescribed by the doctor.

The image is taken from Hamilton Cardiology Associates

What is dyslipidemia?
Dyslipidemia is the variation of lipids in the blood. These lipids can be cholesterol, triglycerides,high-density lipoproteins(HDL) and low-density lipoproteins(LDH). In a study done, 51.6% of kids and teenagers developed dyslipidemia after being diagnosed with Type 2 Diabetes[3].

But what are these lipids that can cause harm in our body?

  • Cholesterol is a very important molecule in our body because it helps make tissues, cell walls, hormones, vitamin D and bile acids. Having too much cholesterol in our blood can block the blood vessels which makes it difficult for blood to travel and that can cause cardiovascular problems.
  • Triglycerides are stored in the body and are released as energy when the body needs some.
  • HDLs help get rid of LDLS. The reason why HDLs do that is because LDH forms plaques in blood vessels and can block blood vessels.
  • Having high levels of cholesterol, triglycerides, HDL and LDL all contribute to cardiovascular problems like heart attacks or strokes.

The most common treatment for dyslipidemias is statins. Statins work to lower LDL levels by interfering with cholesterol production from the liver.

What is diabetic kidney disease?

Diabetic kidney disease happens when high blood glucose damages the blood vessels of the kidneys which prevent the kidney from filtering blood efficiently. We can detect that there is a kidney problem by looking at albumin levels in the urine. If there are high levels of albumin in urine that means that the kidney isn’t filtering blood correctly because proteins are too big to filter out of the kidney. 54.8% of children and adults who developed diabetic kidney disease have type 2 diabetes when transitioning to adulthood[3].

Diabetic kidney disease treatment depends on each individual child, teenager or young adult. Some may need kidney dialysis or a transplant and some only symptom management by maintaining blood glucose levels.

This image is taken from the Mayo Clinic.

This image is taken from the Mayo Clinic.

What is diabetic retinal disease?

Diabetic retinal disease is also known as diabetic retinopathy. This condition causes blindness and vision loss in people with diabetes. The high glucose levels in the blood damage the blood vessels that surround the retina. As sugar builds up in the blood vessels and blocks the pathway that leads to the retina. The retina is the sensitive layer of tissue that is found at the back of the eye which sends messages to the brain about what they are seeing. A study determined that this disease increased from 13.7% in 2011 to 51% in 2018 in young children and teenagers who were transitioning to adulthood[3].

Some treatments available for diabetic retinal disease are injections known as anti-VEGF, laser treatment or eye surgery.

  1. The anti-VEGF injections are responsible for slowing down diabetic retinopathy and improving vision. When you have diabetic retinal disease like diabetic retinopathy our bodies produce more of a protein(VEGF) than they should which causes blood vessels to leak[4].
  2. Laser treatment is used to shrink blood vessels in the eye that are leaking and causing vision problems. This also reduces swelling in the retina[5].
  3. The eye surgery is called a vitrectomy and it is only recommended when the retina is bleeding a lot or if you have scars in your eye[6].

This image is taken from Manhattan Eye Specialists.

This image is taken from Manhattan Eye Specialists.

What is Diabetic Nerve Disease?

Diabetic Nerve Disease or Diabetic Neuropathy is caused by high blood glucose levels and high triglyceride levels that damage the nerves. In a study, 32.4% of youth suffered from diabetic neuropathy[3]. There are four different types of neuropathy: peripheral, autonomic, focal and proximal neuropathy.

  • Peripheral neuropathy affects the feet and the legs.
  • Autonomic neuropathy affects the nerves that control the internal organs and this can lead to other problems with the heart, digestive system, eyes etc.
  • Focal neuropathy affects mostly the hands, torso, leg or head by damaging one nerve only.
  • Proximal neuropathy is very rare and it can cause damage to nerves in the hips or thighs.

You cannot reverse diabetic neuropathy but there are treatments to relieve symptoms and those are paracetamol, capsaicin cream, or tramadol. Tramadol is only prescribed by your doctor.

Prevention of Type 2 Diabetes in Youth.

One of the main reasons that type 2 diabetes occurs in youth is due to obesity. Controlling this risk factor can play a significant role in a young person’s life. To do so kids should:

  1. Exercise more
  2. Drink more water
  3. Eat more fruits and vegetables
  4. Limit sugary drinks
  5. Ensure kids get as much sleep as they need

All of these precautions are taken in order to maintain normal glycemic levels, improve insulin sensitivity, and prevent macrovascular complications.

 

What next?

Type 2 diabetes has been researched in youth for the past two decades and we have got a lot of information on how type 2 diabetes occurs and how we can prevent and treat it. The biggest issue right now is finding a cure for type 2 diabetes. Researchers have been focused on how stem cells could potentially be a cure for Type 2 diabetes


© COPYRIGHT: This article is the property of We Speak Science, a non-profit organization, cofounded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by Hegi Kalaj.

References:

1. Valaiyapathi, B., Gower, B. and Ashraf, A.P. (2020) Pathophysiology of type 2 diabetes in children and adolescents, Current diabetes reviews. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516333/ (Accessed: November 21, 2022).

2. A., Carol Wysham & Jay Shubrook.This work was supported by Sanofi US (no date) Beta-cell failure in type 2 diabetes: Mechanisms, markers, and clinical implications, Taylor & Francis. Available at: https://www.tandfonline.com/doi/full/10.1080/00325481.2020.1771047 (Accessed: November 21, 2022).

3. T.O.D.A.Y.S. et al. (2021) Long-term complications in youth-onset type 2 diabetes: Nejm, New England Journal of Medicine. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa2100165 (Accessed: November 21, 2022).

4. Injections to treat eye conditions (no date) National Eye Institute. U.S. Department of Health and Human Services. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy/injections-treat-eye-conditions (Accessed: November 21, 2022).

5. Laser treatment for diabetic retinopathy (no date) National Eye Institute. U.S. Department of Health and Human Services. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy/laser-treatment-diabetic-retinopathy (Accessed: November 21, 2022).

6. Vitrectomy (no date) National Eye Institute. U.S. Department of Health and Human Services. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinal-detachment/vitrectomy (Accessed: November 21, 2022).