Trends, clinical characteristics, and risk factors of young-onset diabetes at a tertiary care diabetes centre in India

Background & Aim There has been an increase in the occurrence of young-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) in India. In this report, we outline the trends of young-onset T1D and T2D observed at a tertiary care diabetes centre in India. Methods We conducted a retrospective study involving 10,449 individuals diagnosed with diabetes at age ≤25 years who were registered from 2010 to 2023 at a network of diabetes centre in India. T1D was identified through a history of ketoacidosis, low C-peptide levels, or the necessity of insulin from the time of diagnosis. T2D was diagnosed based on the absence of ketosis, sufficient C-peptide levels, a positive response to oral hypoglycemic agents for over two years, and the presence of acanthosis nigricans. Results Of 10,449 participants, 45.5% had T1D, 51.6% had T2D, and 2.8% had maturity-onset diabetes (MODY), Gestational diabetes (GDM), and Fibrocalculous Pancreatic Diabetes (FCPD). The average age at diagnosis of diabetes was higher in T2D (21.1 ± 3.8 years) than in T1D (13.5 ± 6.4 years). The prevalence of young-onset T1D and T2D (as a proportion of all registered patients) increased from 1.1% in 2010 to 1.3% and 1.6% respectively, in 2023. Among those with diabetes with a duration of ≥15 years, retinopathy was found in 61.0% of T1D and 53.9% of T2D, nephropathy in 14.0% and 19.0%, and neuropathy in 29.7% and 50.1%, respectively. Logistic regression, adjusting for relevant factors, indicated that age at diagnosis, BMI, physical inactivity, and parental history were associated with increased risk of young-onset T2D. The Shapley Additive exPlanations (SHAP) analysis identified underweight, age at diagnosis, and parental history as significant determinants for T1D. Conclusion Young-onset diabetes is increasing in prevalence and represents a significant public health challenge because of prolonged disease exposure and increased risk of complications. Early screening and targeted interventions are essential to prevent these complications.