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Cited by 824Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Type 2 diabetes in adolescents and young adults

Open access
Lascar, Nadia, Brown, James, Pattison, Helen, Barnett, Anthony H, Bailey, Clifford J, Bellary, Srikanth·2018·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(17)30186-9
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Abstract

The prevalence of type 2 diabetes in adolescents and young adults is dramatically increasing. Similar to older-onset type 2 diabetes, the major predisposing risk factors are obesity, family history, and sedentary lifestyle. Onset of diabetes at a younger age (defined here as up to age 40 years) is associated with longer disease exposure and increased risk for chronic complications. Young-onset type 2 diabetes also affects more individuals of working age, accentuating the adverse societal effects of the disease. Furthermore, evidence is accumulating that young-onset type 2 diabetes has a more aggressive disease phenotype, leading to premature development of complications, with adverse effects on quality of life and unfavourable effects on long-term outcomes, raising the possibility of a future public health catastrophe. In this Review, we describe the epidemiology and existing knowledge regarding pathophysiology, risk factors, complications, and management of type 2 diabetes in adolescents and young adults.

Integrity signals

Registry

Crossref · 10.1016/s2213-8587(17)30186-9

Cites

147 of 147 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 80 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    Apparent ethnic differences based on regional prevalence data are limited because diagnostic criteria and data collection methods are not always consistent.

    “However, apparent ethnic differences based on regional variations in prevalence (table 1), have the limitation that the diagnostic criteria and methods of data collection are not always consistent [15][16][17] .”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [15] Kim, 2010, The clinical characteristics of the newly diagnosed early onset (<40 years old) diabetes in outpatients' clinic, Korean Diabetes J source

      The Discussion reports regional differences in early-onset diabetes prevalence and says differing patient recruitment and data-collection methods could explain discrepancies between studies. It also shows that studies used different age cutoffs, but does not establish that diabetes diagnostic criteria were inconsistent or specifically assess ethnic differences. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [16] Chuang, 2006, Comparisons of the outcomes on control, type of management and complications status in early onset and late onset type 2 diabetes in Asia, Diabetes Res Clin Pract source
    • cites [17] Jimenez-Corona, 2010, Early-onset type 2 diabetes in a Mexican survey: results from the National Health and Nutrition Survey 2006, Salud Publica Mex source
  • Premisecitation

    A comparable decline in second-phase insulin secretion would take more than a decade to appear in most patients whose type 2 diabetes presents in middle or later life.

    “Such a decrease in second phase insulin secretion would take more than a decade to emerge in most T2DM patients presenting in middle or later life [21][22] .”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [21] Bagust, 2003, Deteriorating beta–cell function in type 2 diabetes: a long–term model, QJM source
    • cites [22] Kahn, 2003, The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes, Diabetologia source

      The intravenous-testing section (p. 8) reports reduced second-phase insulin responses in people at high risk of type 2 diabetes, supporting the claim that this response can decline. It does not say that a comparable decline takes more than a decade in most patients whose diabetes presents in middle or later life; the longitudinal study discussed on p. 7 followed a different, high-risk population for an average of five years. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Intrauterine environment changes influence obesity and type 2 diabetes development more strongly in adolescents and young adults than in later life.

    “Changes in the intrauterine environment influence development of obesity and type 2 diabetes in adolescents and young adults more strongly than in later life.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [31] Reinehr, 2016, Inflammatory markers in obese adolescents with type 2 diabetes and their relationship to hepatokines and adipokines, J Pediatr source
    • cites [32] Vrachnis, 2012, Impact of maternal diabetes on epigenetic modifications leading to diseases in the offspring, Exp Diabetes Res source

      Section 3 (page unavailable) says exposure to a diabetic intrauterine environment contributes to obesity and diabetes in offspring. Section 2.2 reports higher diabetes incidence among exposed offspring in all age groups, but neither passage says the effect is stronger in adolescents and young adults than later in life. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Maternal undernutrition and overnutrition are linked to a greater increased risk of obesity and type 2 diabetes in adolescence and early adulthood than later in life.

    “Maternal undernutrition and overnutrition are associated with a greater increased risk of obesity and type 2 diabetes in adolescence and early adulthood than in later life ,31,32 .”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [31] Reinehr, 2016, Inflammatory markers in obese adolescents with type 2 diabetes and their relationship to hepatokines and adipokines, J Pediatr source
    • cites [32] Vrachnis, 2012, Impact of maternal diabetes on epigenetic modifications leading to diseases in the offspring, Exp Diabetes Res source

      Section 3 (page unavailable) links exposure to a diabetic intrauterine environment with greater offspring risk of obesity and diabetes. It does not address maternal undernutrition or show that the risk is greater in adolescence and early adulthood than later in life. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Insulin resistance is directly related to a higher percentage of fat in muscle and liver across all age groups.

    “However, IR is directly related to an increased percentage of fat in muscle and liver in all age groups 6 ,”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Mayer-Davis, 2017, Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012, N Engl J Med source

      The Discussion (page unavailable) says that changes in obesity prevalence among youths may contribute to changes in insulin resistance. It does not address fat percentages in muscle or liver, a direct relationship with insulin resistance, or all age groups; searches for muscle and liver fat found no such passage. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • May combine two claims. 28
  • Classified as probably not a substantial claim. 6

  • May combine two claims.

    Premisecitation

    A 20-35% yearly decline in beta-cell function has been reported in 10-19 year olds, compared with about 7% loss in older people with type 2 diabetes.

    “A 20-35 % decline in beta cell function annually in 10-19 year olds has been reported compared to the ~7% loss in older individuals with T2DM 23 .”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [23] 2013, Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and β-cell function in TODAY, Diabetes Care source

      The Conclusions report a 20–35% annual decline in β-cell function in the TODAY treatment groups and cite an approximately 7% annual decline in an adult study. The Study design section says TODAY participants were 10–17 years old at randomization, so the cited paper does not establish the claim’s stated 10–19-year-old age range. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In US youth aged 10 to 19 years, type 2 diabetes prevalence rose by 30.5% between 2001 and 2009, reaching 0.48 per 1000.

    “Prevalence estimates suggest a 30•5% increase in T2DM amongst US youth aged 10 to 19 years between 2001 and 2009, accounting for prevalence of 0•48 per 1000 in this age group 5 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Dabelea, 2014, Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009, JAMA source

  • May combine two claims.

    Premisecitation

    The SEARCH study found an annual 7.1% rise in type 2 diabetes incidence among US 10-19 year olds, from 9 per 100,000 in 2002-2003 to 12.5 per 100,000 in 2011-2012, with significant relative increases in all ethnic groups compared with non-Hispanic Whites.

    “Recent data from the SEARCH study showed an annual increase of 7.1% in the incidence of T2DM (9 cases per 100,000 in 2002 -2003 to 12.5 cases per 100,000 in 2011-2012) amongst 10-19 year olds in the USA with significant relative increases in all ethnic groups compared to non Hispanic Whites 6 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Mayer-Davis, 2017, Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012, N Engl J Med source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Younger people with type 2 diabetes can have up to three times more liver fat than BMI-matched non-diabetic controls and than middle-aged or older type 2 diabetes presentations.

    “and younger people with T2DM can have much higher (up to 3 times) amounts of liver fat compared with BMI-matched non-diabetic controls and compared with presentations of T2DM in middle and later life 24,”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Bacha, 2013, Progressive deterioration of β-cell function in obese youth with type 2 diabetes, Pediatr Diabetes source

      The Results section (‘Study subjects and fasting metabolic profile’; page unavailable) reports abdominal fat and hepatic insulin sensitivity, but not liver-fat amounts. Searches for liver fat, intrahepatic fat, and a threefold difference found no comparison with BMI-matched non-diabetic controls or older people with type 2 diabetes in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Physical activity declines further in adolescents than in younger children, and only a small proportion meet recommended levels; surveys in Europe and North America indicate about 80% of 13-15 year olds do less than 60 minutes of moderate or vigorous exercise daily, with girls less active than boys.

    “Physical activity declines further in adolescents compared with younger children and only a small proportion meet recommended levels, eg recent surveys in Europe and North America indicate that about 80% of 13-15 year-olds undertake moderate or vigorous exercise for less than 60 minutes per day, with girls being less active than boys [46][47][48][49] .”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [46] Dollman, 2005, Evidence for secular trends in children's physical activity behaviour, Br J Sports Med source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [47] Kautiainen, 2005, Use of information and communication technology and prevalence of overweight and obesity among adolescents, Int J Obes source
    • cites [48] Hallal, 2012, Global physical activity levels: surveillance progress, pitfalls, and prospects, Lancet source

  • May combine two claims.

    Premisecitation

    Among youth, the main contributors are increasing intake of calorie-dense foods and sugar-rich drinks and decreasing physical activity.

    “Increasing consumption of calorie dense foods, and sugar-rich drinks and decreased physical activity are the main contributors amongst youth 39 .”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [39] Steyn, 2004, Diet, nutrition and the prevention of type 2 diabetes, Public Health Nutr source

      The Physical inactivity section identifies inactivity as a risk factor for type 2 diabetes, and Recommendations and policy implications advises a diet low in free sugars alongside regular activity. The paper notes younger onset of diabetes, but these passages do not establish that calorie-dense foods and sugar-rich drinks, together with inactivity, are the main contributors specifically among youth. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The SEARCH study found few differences in macronutrient or fibre intake between youths with type 1 versus type 2 diabetes, but those with type 2 diabetes consumed twice as many sweetened beverages.

    “Indeed, the SEARCH study showed few differences in macronutrient or fibre intake between youths with T1DM versus T2DM, but those with T2DM consumed twice the amount of sweetened beverages 44 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] Hu, 2010, Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence, Physiol Behav source

      The Prospective cohort studies sections discuss sweetened-beverage intake and diabetes risk, but do not report the SEARCH study’s comparison of youths with type 1 versus type 2 diabetes. Searches for SEARCH, macronutrient and fibre intake, and the claimed twofold beverage difference found no passage addressing that comparison. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The global overweight and obesity pandemic now affects 36.9% of men, 38% of women, 23.8% of boys and 22.6% of girls.

    “The global pandemic of overweight and obesity now affects 36.9% of men,38% of women, 23.8% of boys and 22.6% of girls 37 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [37] Yessoufou, 2011, Maternal diabetes in pregnancy: early and long-term outcomes on the offspring and the concept of “metabolic memory”, Exp Diabetes Res source

      Section 8 says obesity prevalence is increasing worldwide and that the pandemic affects children and adults. It does not give the claimed percentages for men, women, boys, or girls; searches for those figures and for global prevalence by sex and age found no such estimates in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Obesity is clearly a driver of the rise in young-onset type 2 diabetes, and lifestyle changes explain much of the increased obesity and type 2 diabetes prevalence in pre-adult and early adult life.

    “Although the causes of obesity in children and adolescents are complex, obesity is clearly a driver for the upsurge in T2DMY and changes in lifestyle account for much of the increased prevalence of obesity and T2DM in pre-and early-adult life 38 .”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [38] Ng, 2014, Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet source

      The Discussion (page not provided) says rising overweight and obesity can drive up diabetes, and the Results report increasing obesity at younger ages. It does not establish a rise in young-onset type 2 diabetes specifically. The Discussion lists diet and physical activity among possible contributors to obesity but explicitly says the analysis does not measure their relative contributions, so it does not support the claim that lifestyle changes explain much of the increase. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Obese adolescents are reported to have chronically raised circulating free fatty acids, which reduce insulin sensitivity and may increase reactive oxygen species and impair insulin secretion.

    “Compared with non-obese adolescents, obese adolescents are reported to have chronically increased circulating free fatty acids (FFA) which decrease insulin sensitivity and may contribute to increased reactive oxygen species and impair insulin secretion 29 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] Cree-Green, 2013, Etiology of insulin resistance in youth with type 2 diabetes, Curr Diab Rep source

      The “Mechanisms of Insulin Resistance in Children with T2DM” section reports increased FFA concentrations in obese children and describes how FFA can decrease insulin sensitivity, increase reactive oxygen species, and lead to defective insulin secretion. It does not establish that the FFA elevation is chronic or explicitly compare FFA concentrations in obese and non-obese adolescents. No page number is available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationreasoning

    Developing diabetes at a younger age means longer exposure to the disease and a higher chance of chronic complications, affecting more people of working age and worsening societal effects.

    “Onset of diabetes at a younger age is associated with longer disease exposure and increased risk for chronic complications affecting more individuals of working age and accentuating adverse societal impact of the disease.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    About 8% of adults globally have diabetes, over 90% of them type 2, and this is projected to exceed 10% by 2040.

    “The global prevalence of adults with diabetes is around 8% (>90% of whom have T2DM)with projections to increase to over 10% by 2040 1 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Earlier onset results in longer lifetime hyperglycaemia exposure and therefore a greater likelihood of long-term complications.

    “Earlier onset leads to longer lifetime exposure to hyperglycaemia and consequently greater propensity for long term complications.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The diabetes risk estimates for Hispanic and black persons are double those for the general population, indicating disproportionate ethnic impact.

    “These estimates are doubled for Hispanic and black persons suggesting that certain ethnic groups are disproportionately affected 14 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Narayan, 2003, Lifetime risk for diabetes mellitus in the United States, JAMA source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The International Diabetes Federation estimated that in 2000 there were about 23 million young adults aged 20-39 with type 2 diabetes worldwide, representing 13% of 177 million adults with diabetes.

    “The International Diabetes Federation estimated that in the year 2000 young adults aged 20-39 years with T2DM numbered approximately 23 million worldwide (13% of 177 million adults with diabetes 8 ).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] 2000

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Young diabetic groups show an aggressive phenotype with early complications, worse quality of life and poorer long-term outcomes, which could become a public health disaster.

    “Evidence is also accumulating that young diabetic cohorts represent an aggressive phenotype leading to premature development of complications with an adverse impact on quality of life and unfavourably influencing long term outcomes, raising the possibility of a future public health catastrophe.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    By 2013 the estimated number of young adults aged 20-39 with type 2 diabetes had grown to 63 million, or 16% of 382 million adults with type 2 diabetes, with the largest increases in Africa, South East Asia and the Western Pacific.

    “By 2013 this had increased to an estimated 63 million (16% of 382 million adults with T2DM [9][10][11] ), the biggest increases being in Africa, South East Asia and the Western Pacific regions (Figure 1).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [9] 2003

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10] 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Type 2 diabetes in young people affects more working-age individuals, which further increases its negative societal impact.

    “Moreover,T2DMY affects more individuals of working age which further accentuates its adverse societal impact.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although obesity is a prominent risk factor for young-onset type 2 diabetes, studies of insulin resistance, lipid metabolism and inflammation support the idea that hyperglycaemia in this age group depends more on beta-cell failure than in later-life type 2 diabetes.

    “While obesity is clearly a prominent risk factor for T2DMY, studies focussed on IR, lipid metabolism and inflammation corroborate evidence in the previous section suggesting that the development of 'diabetic' hyperglycaemia in this age group appears to be more strongly dependent on beta-cell failure than T2DM in later life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Although aerobic exercise can delay or prevent type 2 diabetes in older adults, the expected metabolic benefits from aerobic activity are comparatively smaller in those with young-onset type 2 diabetes.

    “Although aerobic exercise can delay or prevent the development of type 2 diabetes in older adults, the expected metabolic benefits derived from aerobic activity are comparatively less in those with T2DMY 52 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Gustat, 2002, Relation of self-rated measures of physical activity to multiple risk factors of insulin resistance syndrome in young adults: the Bogalusa Heart Study, J Clin Epidemiol source

  • May combine two claims.

    Premisecitation

    Bariatric surgery is safe and effective in adolescents with obesity.

    “there is now evidence that it is safe and effective in obese adolescents [145][146] .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [145]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [146]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Observational studies in adolescents of different ethnic groups confirm early beta-cell deterioration in young-onset type 2 diabetes, closely linked to insulin resistance severity in African-American adolescents but less so in white Europids and South Asians.

    “Separate observational studies in adolescents of different ethnic groups have similarly confirmed the early deterioration of beta-cell function with T2DMY: this was closely associated with the severity of insulin resistance (IR) in African-American adolescents but less so in white Europids and South Asians 25,26 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Mohan, 2013, Associations of β-cell function and insulin resistance with youth-onset type 2 diabetes and prediabetes among Asian Indians, Diabetes Technol Ther source
    • cites [26] Wilmot, 2014, Early onset type 2 diabetes: risk factors, clinical impact and management, Ther Adv Chronic Dis source

  • May combine two claims.

    Premisecitation

    Regular sweetened beverage consumption raises energy intake by about 10%, while larger portions, fast food access and snack advertising increase adiposity in children, adolescents and young adults.

    “Regular consumption of sweetened beverages increases energy consumption by about 10%, while increased portion sizes, access to fast foods and targeted advertising of snacks increase adiposity in children, adolescents and young adults 40,41 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Ebbeling, 2002, Childhood obesity: public-health crisis, common sense cure, Lancet source
    • cites [41] Swinburn, 2011, The global obesity pandemic: shaped by global drivers and local environments, Lancet source

  • May combine two claims.

    Premisecitation

    Evidence on bariatric surgery in young people with type 2 diabetes is limited but encouraging.

    “Data in youth with type 2 diabetes are limited but nevertheless encouraging with significant improvements in weight and glycaemic indicators as seen in older adults (ref).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites ref

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductcitation

    In adolescents with type 2 diabetes, the relationship between obesity degree and insulin resistance extent has not been consistent, and data are insufficient to determine the role of visceral adiposity in this age group.

    “In contrast, a relationship between the degree of obesity and the extent of IR has not been a consistent finding in studies of adolescents with T2DM, and there are insufficient data to determine the involvement of visceral adiposity in this age group 19 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Druet, 2006, Characterization of insulin secretion and resistance in type 2 diabetes of adolescents, J Clin Endocrinol Metab source

  • May combine two claims.

    Premisecitation

    Better transportation, television viewing and video games all contribute to sedentary behaviours.

    “Nevertheless, better transportation, television viewing and video games all contribute to sedentary behaviours 45 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Mayer-Davis, 2006, Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study, J Am Diet Assoc source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The T2DMY phenotype is characterised by a stronger family history.

    “The T2DMY phenotype has a stronger family history”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The T2DMY phenotype shows early development and fast worsening of microvascular and macrovascular complications.

    “early onset and rapid progression of micro-and macrovascular complications”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The continued rise of obesity and T2DM in young adults affects family members, friends, work colleagues, communities, and the prosperity of high-prevalence localities.

    “The continued escalation of obesity and T2DM in young adults also impinges on the lives of other family members, friends, work colleagues, communities and the prosperity of localities where prevalence is particularly high 147,149 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [147]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [149]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

29 of 29

  • The paper relies on this without support.

    The cited studies' findings can be generalised to the broader population of adolescents and young adults with type 2 diabetes.

    “Increasing numbers of children, adolescents and young adults with T2DM have been reported across most regions of the world.”

  • The authors state this as an assumption.

    The age cutoff of 40 years defines a biologically and clinically meaningful group for the purposes of this review.

    “For this review we have defined T2DMY as onset of type 2 diabetes ( ADA and WHO criteria 3,4 ) in adolescents and young adults up to age 40 years excluding secondary diabetes (drug-or chemicalinduced, exocrine pancreas disease, genetic defects), MODY, gestational diabetes and rare forms of diabetes.”

  • The paper relies on this without support.

    Pregnancy is not uncommon in this age group with T2DMY.

    “Pregnancy is not an uncommon occurrence in this age group”

  • The paper relies on this without support.

    T2DMY can adversely affect maternal and foetal outcomes.

    “the presence of T2DMY can adversely affect maternal and foetal outcomes ( Add reference).”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported annual incidence growth does not match the endpoints

    Minor

    The incidence rises from 9 to 12.5 cases per 100,000 over approximately nine years, equivalent to about 3.7% compound growth per year, not 7.1%. A sustained 7.1% annual increase would produce about 16.7 cases per 100,000.

1 of 1

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Authors
Lascar, N., Brown, J., Pattison, H., Barnett, A. H., Bailey, C. J., & Bellary, S.
Affiliations
  • Aston University (GB)
  • Heart of England NHS Foundation Trust (GB)
Corresponding author
Bellary, Srikanth
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2018-01
Volume
6
Issue
1
Pages
69-80
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(17)30186-9
OpenAlex
W2748764116
Cited by
824
References
150
Citations by year
2026: 73 · 2025: 118 · 2024: 112 · 2023: 118 · 2022: 134 · 2021: 107 · 2020: 99 · 2019: 44 · 2018: 17 · 2017: 2
FWCI
6.48
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Aston Publications Explorer (Aston University) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, youth-onset type 2 diabetes, adolescents, young adults, obesity, family history (medicine), sedentary lifestyle, diabetes risk factors, diabetes complications, disease pathophysiology, diabetes management, quality of life
MeSH terms
Adolescent, Adult, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Male, Quality of Life, Prevalence, Young Adult

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