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Young-onset type2 diabetes mellitusa challenge for Asia
Yifei Zhang and Guang Ning
The prevalence of type2 diabetes mellitus (T2DM) is increasing in young Asian adults; however, little is known about the associated clinical characteristics and the prevalence of complications. A recent Asia-wide prospective cohort study has revealed poor metabolic control in patients with young-onset T2DM, indicating more efcient health-care strategies are warranted to manage this vulnerable population.
Zhang, Y. & Ning, G. Nat. Rev. Endocrinol. 10, 703704 (2014); published online 9 September 2014; http://www.nature.com/doifinder/10.1038/nrendo.2014.162
Web End =doi:10.1038/nrendo.2014.162
The continuing worldwide increase in the prevalence of type2 diabetes mellitus (T2DM) poses serious challenges for health-care systems. In Asian populations, the prevalence of T2DM is expected to increase more rapidly in the future than in the past and with a disproportionate bur den among young and middle-aged individuals.1,2 The reasons for the declining age at onset of T2DM are complicated; however, sedentary lifestyles and an increasing prevalence of obesity in young and middle-aged individuals might partly explain the increasing prevalence of T2DM.3 Unlike late-onset T2DM, limited information is available on the natural history, clinical characteristics, metabolic control and prevalence of complications in young-onset T2DM. However, a recent paper published in The Lancet Diabetes & Endocrinology might provide some answers.4 Yeung and colleagues report data from a large, multinational prospective cohort study (the JADE programme) and show that patients with young-onset T2DM have poorer metabolic control than patients with late-onset disease.4 The findings call for more effective and efficient health-care strategies to manage this vu lnerable population.4
The JADE programme was conducted in 245 institutions in nine countries or regions across Asia.4 In total, 41,029 patients with T2DM were enrolled, among whom 7,481 (18.23%) were patients with young-onset disease (<40years old and 18years of age at the time of diagnosis). Comparison of the clinical characteristics of patients with
young-onset T2DM with those of patients with late-onset disease highlighted three areas of concern. Firstly, the levels of glycaemic control achieved in the group with young-onset T2DM were poor. Even though they are more likely to use insulin, patients with young-onset T2DM achieved higher mean HbA1c levels than patients with late-onset disease (mean 8.32% [SD 2.03] compared with 7.69% [SD 1.82]; P <0.0001,...