Remission of type 2 diabetes following a metabolic program including surgery: a comparative study of young-onset and older-onset type 2 diabetes

Aims: Young-onset type 2 diabetes mellitus (YT2DM) is recognised as an aggressive phenotype when compared with older-onset T2DM (OT2DM). This study aimed to assess whether the proportion with diabetes remission following metabolic surgery (MS) differs amongst adults with YT2DM (diagnosed < 40 years of age) vs OT2DM. Methods: This cohort study included adults with obesity and T2DM that underwent MS between 01/06/2018 and 31/05/2024 at an Australian tertiary hospital. The primary outcome was complete diabetes remission [defined as HbA1c < 6.0% (42 mmol/mol) and at least 3 months off glucose-lowering medications] at 12 months following MS. Results: Compared to those with OT2DM (N = 36), a markedly lower proportion of patients with YT2DM (N = 44) attained complete diabetes remission at 12 months following MS (YT2DM 38.1% vs OT2DM 75.0%, p = 0.002). The difference between groups was not significant on the adjusted model, with baseline HbA1c and duration of T2DM potentially contributing to the observed differences. Conclusions: In contrast to previous reports, our YT2DM cohort had a lower proportion of patients with complete diabetes remission at 12 months after MS. Variables such as baseline HbA1c and T2DM duration appeared as potentially important factors associated with remission. Taken together, our results support the need for early, aggressive obesity treatment in adults with YT2DM, where delaying treatment may potentially close the window of opportunity for diabetes remission.