Youth-Onset Type 2 Diabetes Complications: Long-Term Risks
Youth-onset type 2 diabetes complications can develop much earlier than many people realize. When type 2 diabetes begins during childhood or adolescence, complications such as kidney disease, eye disease, nerve damage, high blood pressure and abnormal cholesterol can appear by young adulthood.
Long-term research shows why early treatment, regular screening and management of blood sugar and cardiovascular risk factors are so important.
Quick Answer: What Are the Long-Term Complications?
Youth-onset type 2 diabetes can lead to kidney disease, diabetic eye disease, nerve damage, high blood pressure, abnormal cholesterol and cardiovascular disease. In the landmark TODAY2 study, 60.1% of participants developed at least one diabetes-related complication by young adulthood, while 28.4% developed two or more.1
Key Points
- Type 2 diabetes diagnosed during childhood or adolescence can cause serious complications at a relatively young age.
- The TODAY2 study found high rates of hypertension, kidney disease, dyslipidemia, eye disease and nerve disease.
- Higher blood sugar, high blood pressure and abnormal blood lipids were associated with greater complication risk.
- Regular screening and comprehensive diabetes management can help identify and address risk factors and complications early.
Long-Term Complications of Youth-Onset Type 2 Diabetes
One of the most important studies of youth-onset type 2 diabetes complications is the long-term follow-up of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.
Researchers followed participants diagnosed with type 2 diabetes during youth. By the end of follow-up, participants in the primary analysis had an average age of just 26.4 years and had been living with diabetes for an average of 13.3 years.
Despite their young age, complications were common.1
| Complication or Risk Factor | Study Finding |
|---|---|
| High blood pressure | 67.5% |
| Diabetic kidney disease | 54.8% |
| Dyslipidemia | 51.6% |
| Retinal disease | 51.0% at later assessment |
| Nerve disease | 32.4% |
| At least one complication | 60.1% |
| Two or more complications | 28.4% |
These findings show that complications of youth-onset type 2 diabetes can begin accumulating well before middle age.
Why Can Complications Develop So Early?
Youth-onset type 2 diabetes can be particularly aggressive. Insulin resistance and the decline of insulin-producing beta-cell function may progress more rapidly than is typically seen with adult-onset type 2 diabetes.2
An earlier diagnosis also means potentially more years of exposure to high blood sugar and other risk factors.
In the TODAY2 study, hyperglycemia, hypertension and dyslipidemia were among the factors associated with a greater risk of complications.1 This makes managing blood pressure and cholesterol important alongside blood glucose.
Major Complications
Kidney Disease
Diabetes can damage the small blood vessels that help the kidneys filter the blood. Early diabetic kidney disease may cause few noticeable symptoms.
For children and adolescents with type 2 diabetes, the American Diabetes Association (ADA) recommends checking urinary albumin and estimated glomerular filtration rate (eGFR) at diagnosis and annually thereafter.3
Early detection can give the diabetes care team an opportunity to address blood sugar levels, blood pressure and other factors that may contribute to kidney damage.
Diabetic Eye Disease
High blood sugar can damage blood vessels in the retina and lead to diabetic retinopathy.
Early retinopathy may not cause noticeable vision changes. Regular diabetes eye care is important because early retinopathy may not cause noticeable vision changes. For youth with type 2 diabetes, the ADA recommends a dilated and comprehensive eye examination at or soon after diagnosis, with follow-up based on the findings and recommendations of an eye care professional.3
Nerve Damage
Diabetic neuropathy can cause numbness, tingling, burning or pain, particularly in the feet and legs. Nerve damage may also develop without obvious symptoms.
Routine foot and neurological examinations can help identify problems early.
High Blood Pressure and Cardiovascular Risk
High blood pressure was the most common condition measured in the TODAY2 study. Hypertension can increase the risk of kidney damage and cardiovascular disease.
Although major cardiovascular events were much less common than microvascular complications, the TODAY2 researchers documented serious events including heart attacks, heart failure, coronary artery disease and strokes in this relatively young population.1
Abnormal Cholesterol and Triglycerides
Dyslipidemia refers to unhealthy levels of cholesterol or other blood lipids and can contribute to cardiovascular disease.
The ADA recommends lipid screening soon after diagnosis of type 2 diabetes in children and adolescents, preferably after blood glucose has improved, and annually thereafter.3
Who Is at Greater Risk?
Not everyone with youth-onset type 2 diabetes develops complications at the same rate.
The TODAY2 study found that hyperglycemia, hypertension and dyslipidemia were associated with greater complication risk.1
This is why diabetes care should extend beyond glucose levels. Monitoring A1C, blood pressure, cholesterol, kidney function, eye health and nerve health provides a more complete picture of long-term risk.
Can Long-Term Complications Be Prevented or Delayed?
Not every diabetes complication can be prevented, but comprehensive diabetes management can address many of the factors associated with greater risk.
Important parts of care include:
- Working toward an individualized A1C goal
- Managing high blood pressure
- Monitoring cholesterol and triglycerides
- Screening for kidney disease
- Receiving recommended eye examinations
- Checking for nerve and foot problems
- Following an individualized nutrition plan
- Getting regular physical activity
- Taking prescribed medications consistently
- Keeping regular appointments with the diabetes care team
Current ADA guidance emphasizes managing glucose along with cardiovascular risk factors and screening for diabetes-related complications in youth with type 2 diabetes.3
Treatment and Monitoring
Treatment for youth-onset type 2 diabetes should be individualized and managed by a health care team experienced in pediatric diabetes.
Nutrition, physical activity, diabetes education and family support are important parts of care. Medication may also be necessary. Current treatment options can include metformin, insulin, GLP-1 receptor agonists and SGLT2 inhibitors, depending on age, glucose levels, symptoms and individual health needs.3
Early treatment and ongoing monitoring are especially important because complications can begin developing before obvious symptoms appear.
Frequently Asked Questions
Medically reviewed by Dr. Seshadri G. Das, MD
Board Certified in Endocrinology, Diabetes & Metabolism
Last updated: August 2026
References
- TODAY Study Group. Long-Term Complications in Youth-Onset Type 2 Diabetes. New England Journal of Medicine. 2021;385:416–426. https://www.nejm.org/doi/full/10.1056/NEJMoa2100165 [↩] [↩] [↩] [↩] [↩] [↩] [↩]
- National Institute of Diabetes and Digestive and Kidney Diseases. Study Finds Risk of Serious Complications from Youth-Onset Type 2 Diabetes. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/study-finds-risk-complications-youth-type-2-diabetes [↩] [↩]
- American Diabetes Association Professional Practice Committee for Diabetes. 14. Children and Adolescents: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl. 1)–S320. https://doi.org/10.2337/dc26-S014 [↩] [↩] [↩] [↩] [↩] [↩]
