Poster 16: The characteristics of lean diabetes in a multi-ethnic urban population

Background: Increasing rates of type 2 diabetes in the young have traditionally been associated with overweight and obesity. However, young-onset type 2 diabetes with low-to-normal BMI has been less well studied. We aimed to compare characteristics of lean and non-lean youth with type 2 diabetes.

Methods: This was a retrospective cross-sectional analysis of individuals with a diagnosis of type 2 diabetes between the age of 18-30 years in an urban inner-city district.

Results: 61 patients were included in the study, age 20.3±3.7 years with 90.1% of non-white ethnicity and Hba1c at diagnosis of 82.2 ±25.8mmol/mol. 13% had a BMI<25.0kg/m2.  The lean vs non-lean group (BMI 22.1± 2.1 vs 34.6 ±6.6 kg/m2) was found to be more likely to have proteinuria at the time of diagnosis (RR=9.00, p=0.0025), and had a lesser reduction in HbA1c with treatment (1.3 ±18.6 vs 19.9 ±26.3 mmol/mol, p=0.043), despite no significant difference in treatment duration, blood pressure, HbA1c at diagnosis or likelihood of insulin requirement. There was no significant difference in terms of retinopathy, dyslipidaemia, ketosis and gender distribution between the two groups. 

Conclusion: Type 2 diabetes has been studied extensively in overweight population but low-to-normal weight group poses a unique challenge in terms of pathophysiology, treatment response and complications. In young onset type 2 diabetes, lean individuals may be more likely to have proteinuria and inadequate treatment response. Further investigation may help us tailor interventions to optimise outcomes in this high-risk group.