Diabetes

Diabetes

Diabetes

This section focuses on the diagnosis and management of diabetes (type 1 and type 2), and its purpose is to meet the educational needs of all healthcare professionals supporting people with diabetes. It has CPD modules on diabetes emergencies, complications, and technologies (including continuous glucose monitoring).

Dr Tom Crabtree
Diabetes & endocrine SpR and clinical research fellow and clinical adviser to MIMS Learning

Identifying and managing young-onset type 2 diabetes

Module description

1.5 CPD hours

Type 2 diabetes typically presents in people who are aged 40 years or older. However, it can also present in people who are younger — known as ‘young-onset type 2 diabetes’ (YOT2D) — and this is linked to the growing number of younger people who are overweight or obese. This module looks at the identification, management and complications of YOT2D.

Educational objectives
After completing this module, healthcare professionals should be more aware of:

The prevalence of YOT2D
Modifiable and non-modifiable risk factors for YOT2D
Management options for YOT2D
How the risk of complications with YOT2D compares with that of type 2 diabetes of typical onset

Introduction

The number of people living with type 2 diabetes is rising at epidemic proportions, leading to increased morbidity and mortality.1 Type 2 diabetes typically presents in people who are aged 40 years or older. However, it can also present in people who are younger — known as ‘young-onset type 2 diabetes’ (YOT2D) — and this is linked to the growing number of younger people who are overweight or obese.

While YOT2D remains a relatively uncommon diagnosis, all healthcare professionals should be aware of it. Not only is YOT2D on the rise, but it also has a more aggressive phenotype than type 2 diabetes of typical onset. It is associated with accelerated beta cell exhaustion and worse cardiovascular and other comorbid outcomes. Additionally, HbA1c targets and annual care processes are less likely to be met in this type 2 diabetes subgroup.

Young-onset type 2 diabetes is linked to the growing number of younger people who are obese.

(Image credit: Me 3645 Studio/Getty Images)

References
1. World Health Organization. Diabetes. April 2023.

Prevalence

Scroll within the image below to view prevalence data about YOT2D.

Primary care data show a consistently rising number of people under 40 years being diagnosed with type 2 diabetes.2

Although people with YOT2D only represent a small proportion (4%) of the overall diabetes population, the incidence of YOT2D is increasing at a faster rate than that of type 2 diabetes of typical onset: 23% versus 18%, respectively, between the years 2016/2017 and 2019/2020.3,4

According to the Global Burden of Diseases study, the incidence of YOT2D in the UK is rising faster than anywhere else in the world.5

The risk of YOT2D increases with age, with most cases occurring between the ages of 26 and 39 (only 1.3% of cases occur in people aged 18 years or younger).3

A 2023 diabetes audit found that there are now more people in England under the age of 40 with type 2 diabetes than those with type 1 diabetes.

Primary care data show a consistently rising number of people under 40 years being diagnosed with type 2 diabetes.2

Although people with YOT2D only represent a small proportion (4%) of the overall diabetes population, the incidence of YOT2D is increasing at a faster rate than that of type 2 diabetes of typical onset: 23% versus 18%, respectively, between the years 2016/2017 and 2019/2020.3,4

According to the Global Burden of Diseases study, the incidence of YOT2D in the UK is rising faster than anywhere else in the world.5

The risk of YOT2D increases with age, with most cases occurring between the ages of 26 and 39 (only 1.3% of cases occur in people aged 18 years or younger).3

A 2023 diabetes audit found that there are now more people in England under the age of 40 with type 2 diabetes than those with type 1 diabetes.

References
2. Holden SH, Barnett AH, Peters JR et al. The incidence of type 2 diabetes in the United Kingdom from 1991 to 2010. Diabetes Obes Metab 2013; 15(9): 844–52.
3. National Diabetes Audit. Young People with type 2 diabetes, 2019-20. August 2021.
4. Diabetes UK (press release). Diabetes UK and Tesco partner to help one million people find out their type 2 diabetes risk. November 2022.
5. Xie J, Wang M, Long Z, Ning H et al. Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ 2022; 379 :e072385.
6. Misra S, Holman N, Barron E et al. Characteristics and care of young people with type 2 diabetes included in the national diabetes audit datasets for England. Diabet Med 2023; 40(1): e14940.

Obesity

The risk factors for YOT2D are similar to those for type 2 diabetes of typical onset, but there are several differences.

Sedentary lifestyle and obesity are two of the most modifiable risk factors for YOT2D. Nearly 90% (88%) of children and young people (under 18 years of age) with YOT2D are overweight or very overweight, and 74% of all people with YOT2D come under these categories.3 Nonetheless, a small percentage are of normal weight or even underweight.

Of note, BMI is calculated differently in children and young people than it is in older age groups. Gender, as well as height and weight, is taken into account and BMI is given as a percentile.

Scroll within the image below to see the BMI categories in children and young people.7

Underweight

On the second centile or below

Healthy weight

Between the second and 91st centiles

Overweight

On 91st centile or above

Very overweight

On 98th centile or above (heavier than 98 of 100 children/young people of the same age/gender)

References
3. National Diabetes Audit. Young People with type 2 diabetes, 2019-20. August 2021.
7. NHS. BMI healthy weight calculator. March 2023. 



Identifying and managing young-onset type 2 diabetes

Type 2 diabetes is increasingly being seen in people under the age of 40 years (young-onset type 2 diabetes). This module, by Dr Sundhya Raman, looks at the presentation, management, and potential complications of this condition.


Identifying and managing young-onset type 2 diabetes

Type 2 diabetes is increasingly being seen in people under the age of 40 years (young-onset type 2 diabetes). This module, by Dr Sundhya Raman, looks at the presentation, management, and potential complications of this condition.

Understanding sexual dysfunction in women with diabetes

1 CPD hour

In this educational module for diabetologists and diabetes specialist nurses, Dr Kirsty Winkley looks at the prevalence, identification, and management of sexual dysfunction in women with diabetes.

Educational objectives
After taking this activity healthcare professionals should be better able to:

Discuss the possible causes of sexual dysfunction in women with diabetes
Review how to identify sexual dysfunction in women
Describe different approaches for treating sexual dysfunction

The role of language for people living with diabetes

1 CPD hour

In this module, Ruth Miller, a diabetes nurse consultant and author of the Diabetes 10 Point Training Programme, explains why language matters for people living with diabetes.

Educational objectives
After taking this activity healthcare professionals should be better able to:

How the language used by healthcare professionals can affect people living with diabetes
Which words and phrases that are outdated
The key principles of the Language Matters movement

Guidance update: latest NICE guidance on continuous glucose monitoring

1 CPD hour

In this module for diabetologists, diabetes specialist nurses, and other healthcare professionals with an interest in diabetes, Dr Isabelle van Heeswijk discusses the 2022/2023 updates to the NICE guidance on type 1 diabetes in adults and to the NICE guidance on diabetes in children and young people.

Educational objectives
After taking this activity healthcare professionals should be better able to:

State what NICE recommends regarding CGM for adults with type 1 diabetes
State what NICE recommends regarding CGM for children and young people with type 1 or type 2 diabetes
Discuss with patients which CGM system is most suitable for them based on their individual needs and wants

Guidance update: latest NICE guidelines on type 2 diabetes in adults

1 CPD hour

Dr Pipin Singh outlines key changes in the 2022 update to NICE guidance on management of type 2 diabetes in adults, including first-line drug treatments and flash monitoring recommendations.

Educational objectives
After taking this activity healthcare professionals should be better able to:

Recall changes in the latest guideline around recommended drug treatments, particularly SGLT2 inhibitors
Consider how frailty and comorbidities are managed in patients with type 2 diabetes
Understand when to refer to secondary care for continuous glucose monitoring
Discuss the importance of individualised HbA1c targets

Understanding sexual dysfunction in women with diabetes

1 CPD hour

In this educational module for diabetologists and diabetes specialist nurses, Dr Kirsty Winkley looks at the prevalence, identification, and management of sexual dysfunction in women with diabetes.

Educational objectives
After taking this activity healthcare professionals should be better able to:

Discuss the possible causes of sexual dysfunction in women with diabetes
Review how to identify sexual dysfunction in women
Describe different approaches for treating sexual dysfunction

The role of language for people living with diabetes

1 CPD hour

In this module, Ruth Miller, a diabetes nurse consultant and author of the Diabetes 10 Point Training Programme, explains why language matters for people living with diabetes.

Educational objectives
After taking this activity healthcare professionals should be better able to:

How the language used by healthcare professionals can affect people living with diabetes
Which words and phrases that are outdated
The key principles of the Language Matters movement

Guidance update: latest NICE guidance on continuous glucose monitoring

1 CPD hour

In this module for diabetologists, diabetes specialist nurses, and other healthcare professionals with an interest in diabetes, Dr Isabelle van Heeswijk discusses the 2022/2023 updates to the NICE guidance on type 1 diabetes in adults and to the NICE guidance on diabetes in children and young people.

Educational objectives
After taking this activity healthcare professionals should be better able to:

State what NICE recommends regarding CGM for adults with type 1 diabetes
State what NICE recommends regarding CGM for children and young people with type 1 or type 2 diabetes
Discuss with patients which CGM system is most suitable for them based on their individual needs and wants

Guidance update: latest NICE guidelines on type 2 diabetes in adults

1 CPD hour

Dr Pipin Singh outlines key changes in the 2022 update to NICE guidance on management of type 2 diabetes in adults, including first-line drug treatments and flash monitoring recommendations.

Educational objectives
After taking this activity healthcare professionals should be better able to:

Recall changes in the latest guideline around recommended drug treatments, particularly SGLT2 inhibitors
Consider how frailty and comorbidities are managed in patients with type 2 diabetes
Understand when to refer to secondary care for continuous glucose monitoring
Discuss the importance of individualised HbA1c targets