Ageing brain abnormalities in young obese patients with type 2 diabetes: a cause for concern

Excerpt

Early onset type 2 diabetes is increasing in prevalence, in parallel with the worldwide obesity epidemic [1], and is typically characterised by early onset obesity and severe insulin resistance in young people with a strong family history of type 2 diabetes [1, 2]. Young patients with type 2 diabetes have been shown to have higher rates of hypertension and microalbuminuria than age-matched peers who have type 1 diabetes, despite better metabolic control and a shorter duration of diabetes [3]. We and others have shown that young obese patients with this phenotype are severely insulin resistant (even when compared with equally obese non-diabetic peers of similar age) and have a characteristic dyslipidaemia, with low HDL-cholesterol and elevated fasting triacylglycerol [2, 4]. It has recently been shown that young type 2 diabetic patients also have blunted or absent metabolic and fitness responses to aerobic exercise training, associated with abnormalities in key muscle mitochondrial regulatory responses to exercise [4, 5]. Given the early onset of diabetes in these young individuals, the marked distinctions between their phenotype and that of typical type 1 diabetes and the potentially long subsequent duration of disease, the most important clinical question, unanswered up to now, has been whether this early onset form of type 2 diabetes will lead to more serious end-organ complications. …