Clinical characteristics, disease course, and clinical subgroups of young adults with type 2 diabetes

Abstract Context Type 2 diabetes (T2D) in young adults is an emerging entity distinct from that in older adults. Objective To identify unique clinical subgroups among young adults using clinical variables. Methods Utilizing the Utah Diabetes Database, a retrospective cohort study was performed with data from 56 327 individuals with T2D as defined by International Classification of Diseases codes and analyzed by predefined groups: young adults (18-44 years) and older adults (≥45 years). De novo k-means clustering was performed. Results Young adults with T2D (yT2D) were more likely to be female (51%), self-identify as racial/ethnic minorities (24%), and have obesity (68%). Compared to older adults, yT2D at baseline had worse glycemic control (hemoglobin A1c [HbA1c] 7.8 ± 2.5% vs 7.3 ± 2.0%, P < .001), higher body mass index (BMI; 34 ± 9 vs 32 ± 7 kg/m2, P < .001) and higher estimated glomerular filtration rate (eGFR; 100 ± 25 vs 73 ± 23 mL/min/1.73 m2, P < .001). Over time, the increase in HbA1c and BMI was greater in yT2D compared with older adults (P < .01) with no difference in eGFR change. Three unique clusters were determined: cluster 1 had higher BMI and lower HbA1c; cluster 2 had a higher HbA1c and was more likely to need insulin; and cluster 3 had a lower eGFR and more diabetes-related comorbidities. Conclusion yT2D have worse glycemic control, greater obesity, and similar renal decline compared with older adults with T2D. A high-risk subgroup of yT2D presents with a significantly lower eGFR. More research is needed to determine whether targeted therapy to high-risk groups will reduce diabetes-related complications.