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In recent years, there has been a concerning rise in the number of people under age 40 being diagnosed with type 2 diabetes. A recent commentary by Naveed Sattar and colleagues, published in The Lancet Diabetes & Endocrinology, sounds the alarm on this – and I couldn’t agree more.
Why is type 2 diabetes on the rise in younger people? Weight gain and less physical activity are central to the problem. Our modern society, rife with unhealthy oversized food choices, less and less need to move around to get things done, poor sleep hygiene (including the effect of smart phone use), mental health, worsening food insecurity and poverty levels, and even the COVID lockdown, have all contributed. More people are being tested for diabetes, with increasing awareness of how early in life diabetes can arise.
Why does it matter that type 2 diabetes is coming on at earlier ages?
- People who have earlier onset of diabetes have earlier onset of complications as well, with more adverse impact on health during their life, in addition to far greater loss of life years (more than a decade) due to diabetes coming on early.
- People with type 2 diabetes starting earlier often have other obesity-related health issues coming on earlier as well, such as high cholesterol, high blood pressure, heart disease, and many others.
- Hemodynamic and cellular stresses can accelerate diabetes complications in younger people (eg kidney disease, heart failure).
- While genetics and ethnicity can certainly predispose to earlier diabetes, another clear risk factor is obesity. Much more weight gain is typically needed to develop type 2 diabetes early in life. More severe obesity is associated with numerous other health consequences. Interestingly, white people typically have to gain more weight than other ethincities to develop type 2 diabetes, especially at younger ages.
- The body’s capacity to produce insulin may decline more rapidly in younger people with type 2 diabetes. This may be related to particularly excessive fat in and around the pancreas.
In people with diabetes, we are always careful to address all aspects of cardiovascular risk, including high blood pressure, cholesterol, and so forth. However, clinical practice guidelines around the world tend to focus on understanding and calculating risks in older people, leaving health care professionals in the lurch about how to assess risk in younger people. This can put younger people with type 2 diabetes at risk of not having the appropriate vascular risk reduction strategies put into place. Guidelines and risk calculators need to catch up with the times, with more robust guidance and assessment tools for younger people urgently needed.
Thankfully, we have an expanding arsenal of excellent diabetes and weight management medications that can help to combat the tide of young-onset type 2 diabetes. By reducing appetite and powerfully reducing weight for many people, these medications make it more feasible to adhere to long term healthy lifestyle strategies (eating well, and being more active at a lower weight). However, cost and access to these treatments remain a major and unacceptable barrier, especially in the face of potentially needing these treatments lifelong.
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