Youth-onset T2DM shows significant clinical and metabolic variability. A cross-sectional analysis published in the Journal of Diabetes and Its Complications characterized early disease subtypes using data-driven cluster analysis.

The study included 641 participants aged 10 to 19 years with newly diagnosed T2D from two major U.S. cohorts. Three distinct subtypes emerged: obesity-related (48.5%), insulin-deficient (18.7%), and insulin-resistant (32.7%). The obesity-related subtype presented with higher BMI and lower HbA1c, the insulin-deficient group showed low fasting C-peptide and high HbA1c, and the insulin-resistant subtype exhibited both high BMI and elevated fasting C-peptide with higher blood pressure levels.

Distal symmetric polyneuropathy was more prevalent among insulin-deficient and insulin-resistant patients compared with those in the obesity-related group. These findings highlight the biological heterogeneity of youth-onset T2D and emphasize the need for individualized diagnostic and therapeutic approaches from disease onset.