Abstract
Youth-onset type 2 diabetes mellitus (YO-T2D) emerged in the United States during the 1990s and subsequently appeared with increasing prevalence globally, generally following increased prevalence of type 2 diabetes among adults in the population. The incidence of T2D in youth has continued to increase over the last 20 years, although it remains a rare disorder even in the United States. The pathophysiology of T2D in youth resembles that in adults: insulin resistance and progressive nonautoimmune β-cell injury. However, since 2004, clinical trials have consistently demonstrated that youth-onset T2D has several unique aspects, including an important association with pubertal development, a high-rate of regression to normal glycemia as pubertal changes wane, and a disease course characterized by rapid progression of β-cell failure in youth with persistent disease, leading to more rapid loss of glycemic control on oral therapy. Finally, growing evidence indicates that microvascular complications and risk markers for macrovascular complications are present at the time of diagnosis and progress rapidly. The underlying pathophysiology of type 2 diabetes in youth, as well as these unique characteristics need to be considered in the approach to management. This talk will review the findings of the pivotal trials that have helped us better understand YO-T2D and provide a physiology-driven approach to use of medications, including recently-approved agents.
