Over the last two decades there has been an increase in the prevalence of type 2 diabetes (T2D) in youth, with further increases recorded during the recent COVID-19 pandemic.1,2 Based on these incidence trends, it has been projected that there will be greater than a 600 % increase in T2D in youth in the coming decades.3 As demonstrated in the Restoring Insulin Secretion (RISE) study, youth onset T2D is characterized by greater insulin resistance and more rapid beta cell deterioration compared to when T2D is diagnosed in adulthood, leading to challenges in management and attainment of optimal glycemic control.4, 5., 6 Further, T2D in youth predominately affects ethnic and racial minority children and adolescents, with worse glycemic outcomes compared to their white peers.7,8

Recent studies highlight the high risk of microvascular and macrovascular complications in youth onset T2D, exacerbated by major risk factors including duration of diabetes and elevated hemoglobin A1c (HbA1c).9,10 The longitudinal TODAY2 study reported that after a mean duration of diabetes of 13 years, and at a mean age of 26.4 years, the mean HbA1c was 9.3 %, and 60 % of study participants had at least one complication of diabetes, and 28 % had at least two complications. The most common comorbidities and complications were hypertension (67.5 %) followed by dyslipidemia (51.6 %), diabetic kidney disease (54.8 %), nerve disease (32.4 %), and retinopathy (51 %). Similarly, the SEARCH for diabetes in youth study also showed high rates of complications, when at a diabetes duration of >10 years, 36 % had diabetic nerve disease, and 55 % had diabetic retinopathy.8,11

These alarming results in young adults with youth-onset T2D were derived from two large cohorts, SEARCH and TODAY, originally established in 2001 and 2004, respectively. In TODAY, participants were on metformin, metformin and rosiglitazone, or lifestyle modification alone at the start of their study participation while the SEARCH cohort was primarily receiving insulin and metformin.7,12 With the ongoing increases in youth onset T2D, and studies suggesting worsening glycemic control during the recent COVID-19 pandemic, along with the recent approval of new diabetes medications for youth, there is a need to understand the real-world prevalence of complications and comorbidities in the youth onset T2D population especially in this newer era of T2D.1,13 In this multicenter analysis of youth with T2D, we sought to assess the prevalence of complications and comorbidities in a real-world, multiethnic, contemporary cohort.