Glucose Homeostasis and Incretin Effect T2DM in the Youth- a Study of the Malaysian Population
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus, Type 2
Study type: Observational

Summary: 
      Early onset type 2 diabetes mellitus among adolescents/youth (YT2DM) is a rising phenomenon.
      The pathophysiology has been studied primarily on non-Asian populations while literature on
      incretin effect is scarce. The investigators evaluated insulin sensitivity, beta-cell
      function, incretin hormones and their effect in YT2DM from a multiethnic Malaysian
      population. The characterization of this population may enable us to better tailor their
      antidiabetic care.
    

Detailed description: 
      -  The prevalence of Type 2 Diabetes Mellitus (T2DM) in the youth is increasing. Until 10
           years ago in USA, T2DM accounted for less than 3% of all cases of new onset diabetes in
           adolescents. More recent data suggest up to 45% of cases are attributed to it.

        -  The prevalence of Diabetes Mellitus in Malaysia has risen from 11.6% to 15.2% over the
           last 5 years according to the National Health and Morbidity Survey in 2011. Among the
           population age 20-24 years old, the prevalence of diabetes has risen also from 2.0% to
           4.9%. Of greater concern still is 90% of these young diabetes were previously
           undiagnosed, thus raising the possibility that these were predominantly T2DM. The report
           from the Malaysian DiCare registry (2006-2007) shows that T2DM accounted for 17.6% of
           diabetes in adolescents. In a more recent audit of diabetes clinic in Penang General
           Hospital in 2012, 56.7% of patients under age of 20 have clinical T2DM (data yet
           unpublished). The marked difference in proportion of young T2DM in both audits may be
           contributed by possible under-reporting in the first audit but raise the possibility
           also of rising incidence of young T2DM in Malaysia.

        -  This rising prevalence of T2DM in the youth has significant public health challenge.
           Studies in young adults have suggested that the development and progression of clinical
           complications might be especially rapid when the onset of T2DM is early. This, coupled
           with longer lifetime exposure to diabetes, raises the possibility of a serious public
           health challenge in the next few decades. Detailed understanding of the pathophysiology
           and complications burden among this population is therefore crucial to the development
           of appropriate management plan.

        -  Studies of youth onset T2DM suggest that it is driven by a combination of insulin
           resistance and beta cell dysfunction, and hyperglycemia does not develop until the beta
           cell fails to compensate appropriately to the peripheral insulin resistance state.
           However, these studies are predominantly done among the western populations and mainly
           in the Black and Hispanic ethnic groups. There are reasons to believe that
           pathophysiology may be different in different populations. The ability of the beta cell
           to secrete sufficient insulin to adequately respond to the peripheral insulin resistance
           state is influenced by genetic and environmental factors. Degree of insulin resistance
           appears to vary among different population studies. There is currently a paucity of
           literature with regards to pathophysiology underpinning T2DM among the Malaysian youth.

        -  The knowledge that incretin effect is severely reduced in patients with adult onset T2DM
           has been used to good pharmacotherapeutic effect in the patients. However, the incretin
           effect is less well studied among T2DM in the youth and understanding in this area will
           be helpful in guiding the use of incretin hormone for treatment of youth onset T2DM.
    

Intervention name(s): OGTT and IVGTT tests
Intervention type(s): Other
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        30 youths with type 2 diabetes with 18 gender- and age-matched healthy controls
      
Keywords: Youth; Type 2 Diabetes; glucose homeostasis; incretin effect