Diabetes In Youth Research Articles

Candidate biomarkers as predictors of future kidney disease and cardiovascular dysfunction in adolescents with type 2 diabetes

AimsEvaluate changes in circulating biomarkers as predictors of kidney disease, and cardiac/vascular dysfunction in participants from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. MethodsCandidate biomarkers were assessed annually in 507 participants over a mean follow-up of 6.9 ± 2.4 years. Moderate albuminuria was defined as urine albumin-to-creatinine ratio ≥ 30 mg/g and hyperfiltration as eGFR ≥ 135 mL/min/1.73 m2 at two consecutive visits. Echocardiography (n = 256) and pulse wave velocity (n = 193) were evaluated twice, 5 years apart. Adjusted Cox proportional hazard models and logistic regression models were used to examine associations between biomarkers and outcomes. ResultsAt baseline, 35.7% were male, with a mean age 13.9 years, diabetes duration 7.8 months, and HbA1c 6.0%. Higher concentrations of E-selectin and proinsulin were associated with incident moderate albuminuria and hyperfiltration. Higher concentrations of FGF-23 were associated with lower risk of hyperfiltration and negatively correlated with eGFR. No candidate biomarkers predicted a decline in cardiac or vascular function. ConclusionsCirculating biomarkers of endothelial dysfunction and markers of β-cell dysfunction and insulin sensitivity could be used in a more personalized risk assessment of kidney disease in youth-onset type 2 diabetes. However, biomarkers studied have limited value in predicting cardiac dysfunction or vascular stiffness.

High Rate of Mortality in Children and Youth with HIV Infection Compared to those with Diabetes in Tanzania

Pediatric and youth diabetes mellitus (DM) and pediatric and youth human immunodeficiency virus (HIV) infection are among the chronic diseases with significant public health implications and high mortality. The availability of mortality statistics in type 1 diabetes and HIV/AIDS is critical for addressing the two conditions in one setting.

Diabetes trends in youth

Type 2 diabetes (T2D) prevalence in the 10- to 19-year-old population has doubled over the past two decades in the United States.1 It is present in nearly 2 persons per 1000 among Black and American Indian youth, in about 1 per 1000 among Hispanic youth, but in 0.2 per 1000 among non-Hispanic white youth, the incidence of T2D has similarly doubled among adolescents in the United States over this period, from 9 to 18 cases per 100 000 per year, with incidence again particularly high in Black and American Indian youth.2 The incidence of type 1 diabetes (T1D) in the United States also increased, from 20 to 22 per 100 000 persons age <20 during the same period,2 and its prevalence increased from 1.5 to 2.2 per 1000,1 with a different racial and ethnic composition, more common in non-Hispanic white, then Black, then Hispanic, then Asian and then American Indian. The numbers of youth with T1D and T2D in 2017 were 185 000 and 28 000, respectively, and, based on these increasing prevalence and incidence rates, the numbers are projected to be 335 000 youth with T1D and 220 000 with T2D in 2060, increases of 65% and 673%, respectively.3 Similarly, T2D and T1D in youth are increasing in incidence and prevalence worldwide. The number of youths with T2D is more than twice as great in China and 1.4-fold higher in India than in the United States based on the larger population of these countries, but with the United States showing the highest reported prevalence in a recent worldwide survey (Table 1).4 The prevalence of T1D among youth in Germany increased similarly from 1.4 per 1000 in 2002 to 2.5 per 1000 in 2020, and although T2D prevalence was considerably lower than in the United States, it again increased more markedly than T1D, from 0.03 to 0.11 per 1000.5 Over the period from 1989 to 2013, T1D in youth in Europe increased at an average annual rate of 3.4%, with the annual rate of increase ranging from approximately 1% in Spain and Italy to 6% in Poland, Romania, and Lithuania.6 To some extent, the growth in T2D is driven by high rates of obesity. Some 20% of US adolescents aged 10–19 years are obese, with the prevalence increasing from 2000 to 2018 and with obesity rates greater among adolescents from households with lower income or lower parental educational level.7 This alone does not seem to fully explain the increase in T2D, however, as it is noteworthy that prediabetes prevalence in adolescents in the United States showed a much greater increase than prevalence of obesity, increasing from 12% in 2000 to 15% in 2005 to 23% in 2011 and to 28% in 2017.8 Other factors may need to be considered. Genomic factors may play a role in the risk of T2D development.9 The concept of social and ethnic determinants of health has been valuable in understanding disparities in onset of T2D in youth and undoubtedly contributes to the burdens both of T1D and T2D in youth.10 Relatively poor glycemic control of youth both with T1D and T2D has been documented in the United States, with mean HbA1c between 8% and 9% and with trends for increasing levels over the past two decades.11 The pattern of worsening glycemic control over the past decade among patients with T2D in the United States has also been shown to extend to young adults at ages 20–44.12 The difficulty of treatment among youths with T2D is noteworthy. A recent study of insulin and/or metformin-treated youth with T2D having baseline HbA1c 8%–8.1% showed glycemic worsening with the dipeptidyl peptidase inhibitor linagliptin and only modest improvement with the sodium-glucose cotransporter-2 inhibitor empagliflozin.13 Along with poor glycemic control there is evidence of development of complications of diabetes in T2D youth. A recent metaanalysis of 27 studies of 5924 youths with T2D showed prevalence of diabetic retinopathy of 2% at <2.5 years diabetes duration, of 5% at 2.5–5 years duration, and of 29% at >5 years duration.14 There is evidence of genomic factors contributing to risk of the development of complications in T2D youths.15 Understanding this burgeoning epidemic and developing more effective therapeutic approaches will be crucial in the coming years. None. None.

Rapid Decline in β-Cell Function and Increasing Adiposity Are Associated With Conversion to Type 2 Diabetes in At-Risk Latino Youth.

Youth-onset type 2 diabetes is becoming increasingly prevalent, especially among Latino youth, and there is limited information on its pathophysiology and causative factors. Overall conversion rate to type 2 diabetes over 5 years was 2%. In youth who converted to type 2 diabetes, disposition index decreased rapidly by 85% compared with that in patients who did not convert during the study period. There was an inverse correlation between rate of decline in disposition index and rates of increase in various adiposity measures.

Examination of Prediabetes and Diabetes Testing Among US Pediatric Patients With Overweight or Obesity Using an Electronic Health Record.

Background: Youth with excess weight are at risk of developing type 2 diabetes (T2DM). Guidelines recommend screening for prediabetes and/or T2DM after 10 years of age or after puberty in youth with excess weight who have ≥1 risk factor(s) for T2DM. Electronic health records (EHRs) offer an opportunity to study the use of tests to detect diabetes in youth. Methods: We examined the frequency of (1) diabetes testing and (2) elevated test results among youth aged 10-19 years with at least one BMI measurement in an EHR from 2019 to 2021. We examined the presence of hemoglobin A1C (A1C), fasting plasma glucose (FPG), or oral glucose tolerance test (2-hour plasma glucose [2-hrPG]) results and, among those tested, the frequency of elevated values (A1C ≥6.5%, FPG ≥126 mg/dL, or 2-hrPG ≥200 mg/dL). Patients with pre-existing diabetes (n = 6793) were excluded. Results: Among 1,024,743 patients, 17% had overweight, 21% had obesity, including 8% with severe obesity. Among patients with excess weight, 10% had ≥1 glucose test result. Among those tested, elevated values were more common in patients with severe obesity (27%) and obesity (22%) than in those with healthy weight (8%), and among Black youth (30%) than White youth (13%). Among patients with excess weight, >80% of elevated values fell in the prediabetes range. Conclusions: In youth with excess weight, the use of laboratory tests for prediabetes and T2DM was infrequent. Among youth with test results, elevated FPG, 2hrPG, or A1C levels were most common in those with severe obesity and Black youth.

From Metabolic Syndrome to Type 2 Diabetes in Youth.

In the frame of metabolic syndrome, type 2 diabetes emerges along a continuum of the risk from the clustering of all its components, namely visceral obesity, high blood pressure and lipids, and impaired glucose homeostasis. Insulin resistance is the hallmark common to all the components and, in theory, is a reversible condition. Nevertheless, the load that this condition can exert on the β-cell function at the pubertal transition is such as to determine its rapid and irreversible deterioration leading to plain diabetes. The aim of this review is to highlight, in the context of metabolic syndrome, age-specific risk factors that lead to type 2 diabetes onset in youth; resume age specific screening and diagnostic criteria; and anticipate potential for treatment. Visceral obesity and altered lipid metabolism are robust grounds for the development of the disease. Genetic differences in susceptibility to hampered β-cell function in the setting of obesity and insulin resistance largely explain why some adolescents with obesity do develop diabetes at a young age and some others do not. Lifestyle intervention with a healthy diet and physical activity remains the pillar of the type 2 diabetes treatment in youth. As to the pharmacological management, metformin and insulin have failed to rescue β-cell function and to ensure long-lasting glycemic control in youth. A new era might start with the approval for use in pediatric age of drugs largely prescribed in adults, such as dipeptidyl peptidase-4 and sodium-dependent glucose transport inhibitors, and of new weight-lowering drugs in the pipeline such as single and multiple agonists of the glucagon-like peptide 1 receptor. The latter drugs can have tremendous impact on the natural history of the disease. By treating diabetes, they will reduce the burden of all the metabolic abnormalities belonging to the syndrome while causing a tremendous weight loss hitherto never seen before.

Diabetes in Pregnancy for Mothers and Offspring: Reflection on 30 Years of Clinical and Translational Research: The 2022 Norbert Freinkel Award Lecture.

Hyperglycemia during pregnancy is a double-edged sword, affecting both mothers and their offspring and creating a vicious cycle that can affect multiple generations. Research in this field over the past 30 years has greatly improved our understanding of this disease and formed the basis of improved strategies to improve the health of mothers and their babies. Despite this progress, gestational and preexisting diabetes continue to have significant effects on both short- and long-term health of mothers and their offspring. In this article, I provide an overview of the work that my colleagues and I have done to advance the knowledge base around diabetes and pregnancy in four areas: 1) diabetes risk after gestational diabetes mellitus (GDM), including racial and ethnic disparities; 2) the pathophysiology of GDM and subsequent diabetes in Hispanic women; 3) diabetes prevention and β-cell preservation following GDM; and 4) evidence for multiple potential developmental effects in offspring that vary according to the timing of exposure and severity of maternal diabetes during pregnancy. This research continues the legacy of Norbert Freinkel and the concepts that he contributed to the field of diabetes and pregnancy. With the epidemic of obesity, increasing rates of type 1 and type 2 diabetes in youth, and rising prevalence of GDM across all racial and ethnic groups, we have a lot more work to do to combat this disease to break the vicious cycle.

Psychosocial factors predict medication adherence in young adults with youth-onset type 2 diabetes: Longitudinal results from the TODAY2 iCount study.

To identify psychosocial predictors of medication adherence in young adults with youth-onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. Participants (mean age: 26 years) completed validated psychosocial measures. Unannounced telephone pill counts were completed at T1 (baseline) and T2 (follow-up, approximately 1year later) to assess adherence to oral hypoglycaemia agents (OHAs). Adherence to insulin was assessed by self-report. Logistic and linear regressions identified factors that predicted 'low adherence' (<80% of pills/insulin) and per cent adherence, adjusted for potential confounders. Of 171 participants with OHA adherence scores at T1 and T2 (65% women, 43% Hispanic and 35% non-Hispanic Black), 65.4% were low adherent. After adjustment (including T1 adherence), concerns about diabetes medicines (adverse effects, dependence) at T1 predicted higher odds of being low adherent (categorical) at T2 (p=0.019). Housing insecurity (p=0.045) and reporting ≥2 need insecurities (p=0.027) at T1 predicted lower per cent adherence (continuous) at T2. Of 157 participants with insulin adherence scores at T1 and T2 (69% women, 38% Hispanic and 38% non-Hispanic Black), 36.3% were low adherent. After adjustment (including T1 adherence), beliefs that medicines are overused predicted higher odds of insulin low adherence at T2 (p=0.013), and beliefs that medicines are harmful (p=0.004) and overused (p=0.010) predicted lower per cent insulin adherence at T2. Suboptimal medication adherence, common in young adults with youth-onset type 2 diabetes, is predicted by interfering beliefs about medicines and social factors. We must address these beliefs and unmet needs to develop tailored interventions for this vulnerable group.

The COVID-19 lockdown increased obesity disparities; Will the increases in type 2 diabetes continue?

The aim of this study was to compare the prevalence of the increases in pediatric obesity during the COVID-19 lockdown with the annual increases in obesity in the National Health and Nutrition Examination Survey (NHANES). This study compared two reports of increases in the prevalence of obesity in youth during the COVID-19 lockdown with the annual rate of increase in obesity in NHANES. When expressed as multiples, the changes in prevalence among elementary school children observed in two population-based surveys were 28 to 63 times greater than the annual changes in the prevalence of obesity observed in NHANES. Increases in Black and Hispanic youth were greater than those in White youth. The net impact of the COVID-19 lockdown increased the disparities in obesity among this age group. The rapid increases in obesity are likely to persist and may be associated with an increase in the prevalence of severe obesity as these children age. Furthermore, the increased susceptibility to diabetes in Hispanic and Black children, as well as the reported increase in diabetes among 0- to 18-year-old individuals during the COVID-19 pandemic, may lead to an increased incidence of type 2 diabetes in minority youth with obesity.

Incidence, Severity, and Presentation of Type 2 Diabetes in Youth During the First and Second Year of the COVID-19 Pandemic.

To describe the evolving impact of the coronavirus disease 2019 pandemic on the incidence and presentation of new-onset pediatric type 2 diabetes. Retrospective medical record review of youth with new-onset type 2 diabetes comparing the prepandemic period (1 January 2017-29 February 2020) with the first (1 March 2020-31 December 2020) and second pandemic year (1 January 2021-31 December 2021). The annualized incidence of type 2 diabetes increased nearly threefold during the pandemic versus prior, with a 61% increase in the 2nd versus 1st year. BMI increased during the pandemic versus prior (129% of 95th percentile vs. 141%, P = 0.02). In the 1st year, patients were younger (12.9 years vs. 14.8, P < 0.001), with higher incidence of diabetic ketoacidosis and/or hyperglycemic hyperosmolar syndrome (20% vs. 3.5%, P = 0.02) versus prior. Providers should be aware of the escalating incidence of youth-onset type 2 diabetes to avoid delays in diagnosis and inform educational programs to combat the continued impact of the pandemic on health outcomes.

Remote Implementation of a School-Based Health Promotion and Health Coaching Program in Low-Income Urban and Rural Sites: Program Impact during the COVID-19 Pandemic.

Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond. The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding. Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation. Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets.

Glucagon-like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained traction for the management of type 2 diabetes and obesity. Unlike several classes of antidiabetic medications that contribute to weight gain, GLP-1RAs not only reduce haemoglobin A1c, but also promote weight loss. While there is a large body of evidence supporting its safety and efficacy in adults, paediatric clinical trial data have only emerged in recent years. This review will discuss the limited treatment options for paediatric type 2 diabetes and the mechanism of action of GLP-1RAs as it pertains to physiological pathways relevant for type 2 diabetes, obesity and their related comorbidities. The outcomes of paediatric trials evaluating liraglutide, exenatide, semaglutide and dulaglutide in paediatric type 2 diabetes and obesity will be closely examined, including differences compared with adult studies. Finally, potential barriers and strategies to expanding GLP-1RA access in adolescents will be discussed. Future studies are needed to determine if the cardio-and renal-protective benefits of GLP-1RAs apply to youth-onset type 2 diabetes.

Psychometric validation of the MIND Youth Questionnaire (MY-Q) to assess quality of life in Spanish patients with type 1 diabetes between 12 and 25 years old

AimValidate in Spanish the Monitoring Individual Needs in Diabetes Youth Questionnaire (MY-Q), a multi-dimensional self-report HRQoL questionnaire designed for paediatric diabetes care. Design and methodsAfter translation, 209 patients diagnosed with type 1 diabetes, between 12 and 25 years old were assessed. The patients belonged to 12 hospitals in Spain. ResultsExploratory factor analysis including one-factor up to seven-factor solutions were tested. The three-factor solution (Negative Impact of Diabetes, Empowerment and Control of Diabetes and Worries) was the most parsimonious model with adequate fit: χ2(723)=568.856 (p<0.001), CFI=0.913, RMSEA=0.072 [0.064, 0.080], SRMR=0.075. The three-factor solution and the grouping of the items followed a clear rationale. Cronbach's alpha was 0.816 for Negative Impact, 0.700 for Empowerment and Control and 0.795 for Worries. The study of the relationship between the MY-Q dimensions and socio-demographics variables show a relationship between age and the MY-Q: F(6,410)=10.873 (p<0.001), η2=0.137. Participants younger than 14 years old showed greater scores on Empowerment and Control when compared to participants between 14 and 17 years old (p=0.021); statistically significant differences were found for the participants 18 years old or older, who showed lower levels of Worries than the younger patients. Concurrent validity found that the dimension of Negative Impact of Diabetes was positively related to WHO-5, and the PedsQL Diabetes Module. ConclusionThe Spanish version of the MY-Q to measure HRQoL in patients with type 1 diabetes between the ages of 12 and 25, has adequate psychometric properties and conceptual and semantic equivalence with the original version in Dutch.

Community Health Worker-led Implementation of the Stanford Youth Diabetes Coaching Program in Underserved Latinx Communities.

The Stanford Youth Diabetes Coaching Program (SYDCP) is an evidence-based program led by health care professionals to teach healthy youth who then coach family members with diabetes or other chronic conditions. This purpose of this study is to evaluate a Community Health Worker (CHW)-led implementation of the SYDCP for low-income Latinx students from underserved agricultural communities. CHWs were trained and virtually led 10 training sessions virtually during the COVID-19 for Latinx students who were recruited from high schools in agricultural regions of Washington state. Feasibility measures include recruitment, retention, class attendance, and successful coaching of a family member or friend. Acceptability was measured by responses on the post-training survey. Effectiveness was evaluated by pre-post changes in measures used in prior studies of the SYDCP such as level of activation and diabetes knowledge. Thirty-four students were recruited, 28 completed the training and 23 returned both pre- and post-surveys. Over 80% of students attended 7 or more classes. All met with a family or friend and 74% met with them weekly. Approximately 80% of the students rated the program's usefulness as "very good" or "excellent." Pre-post increases in diabetes knowledge, nutrition-related behaviors, resilience, and activation were significant and similar to those observed in prior published studies of the SYDCP. Findings support the feasibility, acceptability, and effectiveness of a CHW-led implementation of the SYDCP in underserved Latinx communities using a virtual remote model.

'It's like a never-ending diabetes youth camp': Co-designing a digital social network for young people with type 1 diabetes.

Living with a chronic condition such as type 1 diabetes (T1D) affects everyday life and support from others experiencing a similar situation can be helpful. A way to receive such support is to use an online network where people can connect and share experiences. Research has described the benefits of using such tools for connecting patients. The aim of this study was to describe the co-design of a social network for young people with T1D and to describe their experiences when using this network. A co-design approach was used, following three steps adapted from Sanders and Stappers (2008). In all, 36 adolescents with T1D participated. Data in the form of recordings and notes from telephone interviews, workshops and focus groups were collected and then analysed using content analysis. Numerical data from the digital platform were also used. For the interpersonal values, supporting, learning and relating to emerge, the framework of the network must be appealing and user-friendly. The limits of time and place are eliminated, and there is a possibility for many more to join in. Co-design ensures that what stakeholders think is important forms the basis for the design. The interpersonal values that are promoted are ones that only the exchange of lived knowledge and experience can generate. It is complementary to the support that healthcare professionals can offer; thus, this kind of social network is important for improved, coproduced care. The participants in the present study were persons living with T1D. They were active co-creators from the start to the end. An adult person with experience of living with T1D was involved as an advisor in the research team when drafting the manuscript.

Construction of a new complete growth reference for urban Chinese children

BackgroundGrowth chart is a valuable clinical tool to monitor the growth and nutritional status of children. A growth chart widely used in China is based on the merged data sets of national surveys in 2005. We aimed to establish an up-to-date, complete growth curve for urban Chinese children and adolescents with a full range of ages.MethodsUsing data collected in a large-scale, cross-sectional study (Prevalence and Risk factors for Obesity and Diabetes in Youth (PRODY), 2017–2019), we analyzed 201,098 urban children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations. Sex-specific percentiles of height-for-age and weight-for-age were constructed by Generalized Additive Models for Location Scale and Shape (GAMLSS) model. We also compared the median values of height-for-age or weight-for-age between our growth chart and the established growth reference using Welch-Satterthwaite T-Test.ResultsConsistent with the established growth reference, we observed that the P50 percentile of height-for-age reached plateaus at the age of 15 years (172 cm) and 14 years (160 cm) for boys and girls, respectively. In addition, boys aged 10 ~ 14 years and girls aged 10 ~ 12 years exhibited the most dramatic weight difference compared to those of other age groups (19.5 kg and 10.3 kg, respectively). However, our growth chart had higher median values of weight-for-age and height-for-age than the established growth reference with mean increases in weight-for-age of 1.36 kg and 1.17 kg for boys and girls, respectively, and in height-for-age of 2.9 cm and 2.6 cm for boys and girls, respectively.ConclusionsOur updated growth chart can serve as a reliable reference to assess the growth and nutritional status in urban Chinese children throughout the entire childhood.

Retinal Thickness and Morphology Changes on OCT in Youth with Type 2 Diabetes: Findings from the TODAY Study.

To evaluate changes in retinal thickness and morphology using OCT in youth with type 2 diabetes (T2D) and to identify systemic biomarkers correlating with these changes. Retrospective subgroup analysis of a prospective study. Participants who underwent OCT imaging in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial and its follow-up study TODAY2. In 2010-2011 (TODAY) and 2017-2018 (TODAY2), 6×6-mm macular volume OCT scans were acquired, segmented, and analyzed to generate total retinal thickness, inner retinal thickness, and outer retinal thickness. The main retinal morphologies graded were intraretinal cystoid spaces, subretinal fluid, and posterior vitreous detachment (PVD). Changes in total and individual retinal layer thickness and development of abnormal vitreomacular morphology between TODAY and TODAY2. Participants had a mean age of 17.9±2.4 years and glycated hemoglobin (HbA1c) of 8.2±2.8% in TODAY and a mean age of 25.0±2.4 years and mean HbA1c of 9.5±2.8% in TODAY2. Longitudinally between assessments, there were overall decreases in outer retinal thickness from 167.2±11.5 microns to 158.4±12.8 microns (P<0.001) and in photoreceptor thickness from 30.3±2.9 microns to 29.8±4.1 microns (P=0.04) in the central subfield, while in the inner subfield, we noted a decrease in outer retinal thickness from 150.5±10.1 microns to 144.9±10.5 microns (P<0.001) and an increase in inner retinal thickness from 136.9±11.5 microns to 137.4±12.6 microns (P=0.01). Multivariate analysis showed that in the center subfield, HbA1c increases were associated with increases in total retinal thickness (r: 0.67, P=0.001), whereas fasting glucose was positively correlated with inner retinal thickness (r: 0.02, P=0.02). In the inner subfield, both systolic (r:-0.22, P<0.001) and diastolic (r:-0.22, P=0.003) blood pressures were negatively correlated with total retinal thickness. There was an increase in PVD (18.9%) and cystoid spaces (4.2%). Youth with T2D develop retinal thickness changes on OCT, including increases in total retinal and inner retinal thickness in the center subfield that correlate with HbA1c and fasting glucose, respectively. Taken together with the increased prevalence of abnormal vitreomacular morphology in this cohort at risk, these findings emphasize the importance of controlling risk factors to prevent the development of sight-threatening retinal complications.

Maternal Diabetes in Youth-Onset Type 2 Diabetes Is Associated With Progressive Dysglycemia and Risk of Complications.

Prenatal exposures, including undernutrition, overnutrition, and parental diabetes, are recognized risk factors for future cardiometabolic disease. There are currently no data on effects of parental diabetes on disease progression or complications in youth-onset type 2 diabetes (T2D). We analyzed effects of parental diabetes history on glycemic outcomes, β-cell function, and complications in a US cohort of youth-onset T2D. Participants (N = 699) aged 10 to 17 years with T2D were enrolled at 15 US centers and followed for up to 12 years as part of the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) and TODAY2 follow-up studies. Information about diabetes diagnosis in biological mothers was available for 621 participants (never = 301; before or during pregnancy = 218; after pregnancy = 102) and in biological fathers for 519 (no diabetes = 352; paternal diabetes = 167). Maternal, but not paternal, diabetes was associated with loss of glycemic control over time, defined as glycated hemoglobin A1c greater than or equal to 8% for more than 6 months (P = .001). Similarly, maternal, but not paternal, diabetes was associated with increased risk of glomerular hyperfiltration (P = .01) and low heart rate variability (P = .006) after 12 years of follow-up. Effects were largely independent of age, sex, race/ethnicity, and household income. Maternal diabetes during vs after pregnancy had similar effects on outcomes. Maternal diabetes, regardless of whether diagnosed during vs after pregnancy, is associated with worse glycemic control, glomerular hyperfiltration, and reduced heart rate variability in youth with T2D in TODAY. The strong associations of diabetes outcomes with maternal diabetes suggest a possible role for in utero programming.

#1323006: Cardiometabolic Risk Factors and Insulin Therapy Requirement in Youth with New Onset Type 2 Diabetes during the COVID-19 Pandemic

The incidence of type 2 diabetes (T2D) in youth increased remarkably during the COVID-19 pandemic. We hypothesized that most youth diagnosed with T2D during the COVID-19 pandemic already had abnormal cardiometabolic risk factors before the pandemic. Thus, we aim to determine what specific cardiometabolic risk factors were associated with the requirement of insulin therapy (HbA1C >=8.5%) in youth with a new diagnosis of T2D.

Long-Term Retention of Young Adult Study Participants with Youth-Onset Type 2 Diabetes: Results from the TODAY2 Study

Introduction: The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial examined the effects of three treatment arms in a group of racially and ethnically diverse adolescents and youth with type 2 diabetes mellitus. TODAY2 was an observational follow-up study reporting outcomes and complications in these participants after having diabetes for approximately 13 years. Participant retention was essential to fulfill this objective. This report describes the motivations and problems participants self-reported related to continuing in this study. Methods: The TODAY2 retention survey was administered to participants with a mean age of 27 years, 36% non-Hispanic black, 18% non-Hispanic white, 39% Hispanic, 52% public, and 35% private healthcare coverage, who completed the last study visit (63.8% of original TODAY cohort). The survey listed potential benefits and barriers to staying in the trial. Participants indicated agreement or disagreement with each statement using a four-point Likert-type scale. Results: More than 93% of survey responders agreed with the benefits listed for staying in TODAY2. The most cited reason for staying in the study was related to the strong relationship that participants had with study staff. The common barriers to attending trial visits were tending to other medical problems, fear of disappointing study staff, and school/work scheduling conflicts. Participants with public healthcare coverage were more likely to endorse benefits related to diabetes care (e.g., getting the latest test results, staying motivated to care for my diabetes) and monetary compensation, whereas participants with poor glycemic control cited that a barrier to attending study visits was “fear of disappointing” study staff. Conclusion: In a racially and ethnically diverse population of youth-onset type 2 diabetes, benefits and barriers associated with long-term retention are described. These findings can be used to help inform future retention strategies for young adults in clinical trials.