In the UK, the incidence of Early Onset Type 2 Diabetes (EOT2D; diagnosis <40 years) has increased steadily over the last 30 years. Now, roughly 3.8% of young adults globally have EOT2D.

Type 2 diabetes has classically been considered a condition affecting middle-aged or older individuals, but now the numbers of young adults (under 40 years) living with type 2 diabetes in England exceed those living with type 1 diabetes.

When compared with a diagnosis later in life, diagnosis of EOT2D is often characterised by a more aggressive risk factor profile, including higher body mass index, higher blood pressure, lower physical activity, and more adverse cardiovascular risk profile, with studies showing a more rapid disease progression, higher risk of complications and a shorter life expectancy.

There is an urgent need for interventions for people with EOT2D. These interventions must also consider individual-level factors that may be more common in this population, which include having young families, early careers, a high burden of mental health disease, stigmatisation, higher rates of missed appointments, higher levels of socioeconomic deprivation, and a higher prevalence in people from Asian and Black ethnic groups.

The Leicester Diabetes Centre has an extensive clinical and academic track record with EOT2D. We were one of the first groups to recognise and highlight the lack of targeted research in EOT2D, as evidenced within our seminal 2020 paper[1] showing that people with EOT2D represented less than 5% of participants across 73 global T2D trials of key interventions (including drug, lifestyle and DSMES).

Amongst a population living with EOT2D across Leicester and Sheffield, our team have also shown that EOT2D is underpinned by an extreme risk phenotype, which is accompanied by inadequately treated risk factors and a lack of targeted interventions[2].

Over the last 15 years, the inclusion of patients living with EOT2D has been a key priority for our centre. Highlights include:

• ‘EXPEDITION’ cross-sectional study, which identified impaired cardiac function amongst those living with EOT2D.
• ‘DIASTOLIC’ randomised-controlled trial (RCT), which explored the effect of two lifestyle interventions (diet or exercise) on diabetes related complications, and notably recruited a population of whom 25% were living with EOT2D.
• ‘LYDIA’ RCT compared the efficacy of liraglutide and sitagliptin amongst a population with a mean age of 44 years.
• ‘Project STAND’ RCT explored an education and behaviour-change intervention targeted exclusively at patients living with EOT2D.

We are now examining the impact of a combined low energy diet and supervised exercise intervention (RESET 4 Remission) on type 2 diabetes remission in those aged 18-45 years.

More recently, as part of the ~£2.5 million NIHR-funded M3 Programme, our team has published several epidemiological papers highlighting the increased risk of mortality, obesity, depression, and diabetes-related distress in patients living with EOT2D[3].

Within this programme, a qualitative study has also been conducted to explore the perspectives and unmet needs of people living with EOT2D. The M3 Programme now focuses on investigating a novel, multifactorial intervention tailored specifically to the needs of those with EO2TD within a multi-site RCT.

To find out more about the Leicester Diabetes Centre and our work in EOT2D, visit our stand at the Diabetes Professional Care Conference 2024 and get in touch with us: EOT2D@uhl-tr.nhs.uk

 

[1] Sargeant JA, Brady EM, Zaccardi F, Tippins F, Webb DR, Aroda VR, et al. Adults with early-onset type 2 diabetes (aged 18-39 years) are severely underrepresented in diabetes clinical research trials. Diabetologia. 2020 Aug;63(8):1516–20.

[2] 11. Benhalima K, Wilmot E, Khunti K, Gray LJ, Lawrence I, Davies M. Type 2 diabetes in younger adults: clinical characteristics, diabetes-related complications and management of risk factors. Prim Care Diabetes. 2011 Apr;5(1):57–62. & Benhalima K, Song SH, Wilmot EG, Khunti K, Gray LJ, Lawrence I, et al. Characteristics, complications and management of a large multiethnic cohort of younger adults with type 2 diabetes. Prim Care Diabetes. 2011 Dec;5(4):245–50.

[3] Barker MM, Zaccardi F, Brady EM, Gulsin GS, Hall AP, Henson J, et al. Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile: A pooled analysis. WJD. 2022 Mar 15;13(3):260–71. & Barker MM, Davies MJ, Sargeant JA, Chan JCN, Gregg EW, Shabnam S, et al. Age at Type 2 Diabetes Diagnosis and Cause-Specific Mortality: Observational Study of Primary Care Patients in England. Diabetes Care. 2023 Nov 1;46(11):1965–72. & Barker MM, Davies MJ, Zaccardi F, Brady EM, Hall AP, Henson JJ, et al. Age at Diagnosis of Type 2 Diabetes and Depressive Symptoms, Diabetes-Specific Distress, and Self-Compassion. Diabetes Care. 2023 Mar 1;46(3):579–86.