Long-term complications in youth-onset type 2 diabetes
Open accessAbstract
BACKGROUND: The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood. METHODS: We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of three treatments (metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention) on the time to loss of glycemic control in participants who had onset of type 2 diabetes in youth. After completion of the trial, participants were transitioned to metformin with or without insulin and were enrolled in an observational follow-up study (performed from 2011 to 2020), which was conducted in two phases; the results of this follow-up study are reported here. Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice. Complications related to diabetes identified outside the study were confirmed and adjudicated. RESULTS: At the end of the second phase of the follow-up study (January 2020), the mean (±SD) age of the 500 participants who were included in the analyses was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, the incidence of dyslipidemia was 51.6%, the incidence of diabetic kidney disease was 54.8%, and the incidence of nerve disease was 32.4%. The prevalence of retinal disease, including more advanced stages, was 13.7% in the period from 2010 to 2011 and 51.0% in the period from 2017 to 2018. At least one complication occurred in 60.1% of the participants, and at least two complications occurred in 28.4%. Risk factors for the development of complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia. No adverse events were recorded during follow-up. CONCLUSIONS: Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by the time of young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01364350 and NCT02310724.).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Most children and adolescents who develop type 2 diabetes will have microvascular complications by young adulthood.
“Most children and adolescents who develop type 2 diabetes will have microvascular complications by young adulthood (274);”
The IDx-DR autonomous AI system was US FDA De Novo authorized in 2018 for adults with diabetes.
“The autonomous AI system (IDx-DR, Digital Diagnostics, Coralville, Iowa, USA) for diagnosing diabetic eye disease (DED) was US FDA De Novo authorized (“FDA approval”) in 2018 for adults with diabetes15.”
From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [15]
The Methods section, “Diabetic Eye Disease” (page not provided), describes fundus photography graded at a centralized reading center, not the IDx-DR system. Searches for IDx-DR, FDA De Novo authorization, and autonomous AI found no passage in our copy addressing the claimed 2018 authorization for adults with diabetes. (LLM, conf=0.77)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Blowey, D., Carroll, A. E., Daniels, S. R., de Ferranti, S. D., Dionne, J. M., Falkner, B., Flinn, S. K., et al. (2017) · Pediatrics · doi:10.1542/peds.2017-1904 · Cited by 3,651 · see citing works
Adler, A., Stevens, R., Manley, S. E., Bilous, R., Cull, C. A., Holman, R. R., & UKPDS Group (2003) · Kidney International · doi:10.1046/j.1523-1755.2003.00712.x · Cited by 1,800 · see citing works
Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012
Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J., Isom, S., Dolan, L., Imperatore, G., Linder, B., Marcovina, S., Pettitt, D. J., et al. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1610187 · Cited by 1,476 · see citing works
Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009
Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., Bell, R., Badaru, A., Talton, J. W., Crume, T., et al. (2014) · JAMA · doi:10.1001/jama.2014.3201 · Cited by 1,412 · see citing works
KDIGO 2020 Clinical practice guideline for diabetes management in chronic kidney disease
de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.019 · Cited by 1,399 · see citing works
Feldman, E. L., Stevens, M. J., Thomas, P. K., Brown, M. B., Canal, N., & Greene, D. A. (1994) · Diabetes Care · doi:10.2337/diacare.17.11.1281 · Cited by 1,291 · see citing works
(2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00291-0 · Cited by 1,029 · see citing works
A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes
TODAY Study Group (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1109333 · Cited by 978 · see citing works
Self-citationFundus Photographic Risk Factors for Progression of Diabetic Retinopathy
* (1991) · Ophthalmology · doi:10.1016/s0161-6420(13)38014-2 · Cited by 961 · see citing works
Dabelea, D., Stafford, J. M., Mayer-Davis, E. J., D’Agostino, R., Dolan, L., Imperatore, G., Linder, B., Lawrence, J. M., Marcovina, S. M., Mottl, A. K., et al. (2017) · JAMA · doi:10.1001/jama.2017.0686 · Cited by 700 · see citing works
The 30-Year Natural History of Type 1 Diabetes Complications
Pambianco, G., Costacou, T., Ellis, D., Becker, D. J., Klein, R., & Orchard, T. J. (2006) · Diabetes · doi:10.2337/db05-1423 · Cited by 493 · see citing works
Copeland, K. C., Zeitler, P. S., Geffner, M. E., Guandalini, C., HIGGINS, J. A., Hirst, K., KAUFMAN, F. R., Linder, B. L., Marcovina, S. M., McGuigan, P., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-1642 · Cited by 464 · see citing works
Youth-Onset Type 2 Diabetes Consensus Report: Current Status, Challenges, and Priorities
Nadeau, K. J., Anderson, B. J., Berg, E. G., Chiang, J. L., Chou, H., Copeland, K. C., Hannon, T. S., Huang, T. T.-K., Lynch, J. L., Powell, J., et al. (2016) · Diabetes Care · doi:10.2337/dc16-1066 · Cited by 381 · see citing works
Liraglutide in Children and Adolescents with Type 2 Diabetes
Tamborlane, W. V., Pérez, M. B., Fainberg, U., Frimer‐Larsen, H., Hafez, M., Hale, P. M., Jalaludin, M. Y., Коваренко, М. А., Libman, I. M., Lynch, J. L., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1903822 · Cited by 360 · see citing works
Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., & Zeitler, P. (2018) · Diabetes Care · doi:10.2337/dci18-0052 · Cited by 349 · see citing works
Olbers, T., Beamish, A. J., Gronowitz, E., Flodmark, C.-E., Dahlgren, J., Bruze, G., Ekbom, K., Friberg, P., Göthberg, G., Järvholm, K., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30424-7 · Cited by 318 · see citing works
Rapid Rise in Hypertension and Nephropathy in Youth With Type 2 Diabetes
TODAY Study Group (2013) · Diabetes Care · doi:10.2337/dc12-2420 · Cited by 279 · see citing works
Self-citationThe TODAY Study Group (2007) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2007.00237.x · Cited by 260 · see citing works
Self-citationEarlier Onset of Complications in Youth With Type 2 Diabetes
Dart, A. B., Martens, P. J., Rigatto, C., Brownell, M. D., Dean, H., & Sellers, E. A. C. (2013) · Diabetes Care · doi:10.2337/dc13-0954 · Cited by 251 · see citing works
Alsaeed, A. H., Constantino, M., Molyneaux, L. M., D'Souza, M. I., Limacher-Gisler, F., Luo, C., Wu, T., Twigg, S. M., Yue, D. K., & Wong, J. (2016) · Diabetes Care · doi:10.2337/dc15-0991 · Cited by 251 · see citing works
Amin, R., Widmer, B., Prevost, A. T., Schwarze, P., Cooper, J. D., Edge, J., Marcovecchio, L., Neil, A., Dalton, R. N., & Dunger, D. B. (2008) · BMJ · doi:10.1136/bmj.39478.378241.be · Cited by 200 · see citing works
Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents
Inge, T. H., Laffel, L. M., Jenkins, T. M., Marcus, M. D., Leibel, N. I., Brandt, M. L., Haymond, M., Urbina, E. M., Dolan, L. M., Zeitler, P. S., et al. (2018) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2017.5763 · Cited by 189 · see citing works
The RISE Consortium, Nadeau, K. J., Hannon, T. S., Edelstein, S. L., Arslanian, S. A., Caprio, S., Leschek, E. W., Zeitler, P. S., Buchanan, T. A., Ehrmann, D. A., et al. (2018) · Diabetes Care · doi:10.2337/dc18-0787 · Cited by 176 · see citing works
International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes
Kilpatrick, E. S., Bloomgarden, Z. T., & Zimmet, P. (2009) · Diabetes Care · doi:10.2337/dc09-1231 · Cited by 175 · see citing works
Ehrmann, D. A., Temple, K. A., Rue, A., Barengolts, E., Mokhlesi, B., Cauter, E. V., Sam, S., Miller, M. A., Kahn, S. E., Atkinson, K. M., et al. (2018) · Diabetes Care · doi:10.2337/dc18-0244 · Cited by 169 · see citing works
Ehrmann, D. A., Temple, K. A., Rue, A., Barengolts, E., Mokhlesi, B., Cauter, E. V., Sam, S., Miller, M. A., Kahn, S. E., Atkinson, K. M., et al. (2018) · Diabetes Care · doi:10.2337/dc18-0243 · Cited by 119 · see citing works
Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia
Lozano, P., Henrikson, N. B., Morrison, C. C., Dunn, J., Nguyen, M., Blasi, P. R., & Whitlock, E. P. (2016) · JAMA · doi:10.1001/jama.2016.6423 · Cited by 93 · see citing works
The RISE Consortium, Ehrmann, D. A., Temple, K. A., Rue, A., Barengolts, E., Mokhlesi, B., Van Cauter, E., Sam, S., Miller, M. A., Kahn, S. E., et al. (2019) · Diabetes Care · doi:10.2337/dc19-0556 · Cited by 73 · see citing works
Morton, J. I., Liew, D., McDonald, S. P., Shaw, J. E., & Magliano, D. J. (2020) · Diabetes Care · doi:10.2337/dc20-0352 · Cited by 62 · see citing works
Bjornstad, P., Hughan, K. S., Kelsey, M. M., SHAH, A. S., Lynch, J. L., Nehus, E. J., Mitsnefes, M. M., Jenkins, T. M., Xu, P., Xie, C., et al. (2019) · Diabetes Care · doi:10.2337/dc19-0708 · Cited by 52 · see citing works
Clinical Trials in Youth-Onset Type 2 Diabetes: Needs, Barriers, and Options
Zeitler, P. S., Chou, H. S., Copeland, K. C., & Geffner, M. E. (2015) · Current Diabetes Reports · doi:10.1007/s11892-015-0597-2 · Cited by 26 · see citing works
Bjornstad, P., Nehus, E. J., Jenkins, T. M., Mitsnefes, M. M., Moxey‐Mims, M., Dixon, J. B., & Inge, T. H. (2020) · Kidney International · doi:10.1016/j.kint.2020.01.016 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300 · see citing works
Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., et al. (2022) · Diabetes Care · doi:10.2337/dci22-0034 · Cited by 2,104 · see citing works
Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., et al. (2022) · Diabetologia · doi:10.1007/s00125-022-05787-2 · Cited by 1,048 · see citing works
14. Children and Adolescents: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s014 · Cited by 173 · see citing works
Wolf, R. M., Channa, R., Liu, T. Y. A., Zehra, A., Bromberger, L., Patel, D., Ananthakrishnan, A., Brown, E. A., Prichett, L., Lehmann, H. P., et al. (2024) · Nature Communications · doi:10.1038/s41467-023-44676-z · Cited by 116 · see citing works
Chesser, H., Srinivasan, S., Puckett, C., Gitelman, S. E., & Wong, J. C. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968221139873 · Cited by 40 · see citing works
Putman, M. S., Norris, A. W., Hull, R. L., Rickels, M. R., Sussel, L., Blackman, S. M., Chan, C. L., Ode, K. L., Daley, T., Stecenko, A. A., et al. (2023) · Diabetes Care · doi:10.2337/dc23-0380 · Cited by 35 · see citing works
Diabetes care barriers, use, and health outcomes in younger adults with type 1 and type 2 diabetes
Pihoker, C., Braffett, B. H., Songer, T. J., Herman, W. H., Tung, M., Kuo, S., Bellatorre, A., Isganaitis, E., Jensen, E. T., Divers, J., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.12147 · Cited by 26 · see citing works
- Authors
- TODAY Study Group
- Corresponding author
- TODAY Study Group
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-07-29
- Volume
- 385
- Issue
- 5
- Pages
- 416-426
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8697255
- OpenAlex
- W3187052158
- Cited by
- 546
- References
- 34
- Citations by year
- 2026: 85 · 2025: 121 · 2024: 123 · 2023: 97 · 2022: 97 · 2021: 22
- FWCI
- 63.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Funders
- National Center for Research Resources (M01-RR00036, M01-RR00043-45, M01-RR00069, M01-RR00084, M01-RR00125, M01-RR01066, M01-RR14467, UL1-RR024134, UL1-RR024139, UL1-RR024153, UL1-RR024989, UL1-RR024992, UL1-RR025758, UL1-RR025780)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, U01-DK61254)
- 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
- youth-onset type 2 diabetes, late complications, diabetic nephropathy, hypertension, dyslipidemia, diabetic retinopathy, microvascular complications, hyperglycemia, racial and ethnic disparities, metformin, coming of age, risk factors for complications, lifestyle intervention, rosiglitazone, insulin therapy, glycemic control
- MeSH terms
- Adolescent, Child, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypertension, Hypoglycemic Agents, Male, Metformin, Risk Factors, Diabetes Complications, Dyslipidemias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
