What is the clinical evidence from this study?

Study design: Observational. Population: youth-onset type 2 diabetes (n=677). Intervention: Baseline HbA1c and ALT levels vs. Lower baseline levels. Primary outcome: microvascular complications (nephropathy, neuropathy, and retinopathy) (HR 1.27, 95% CI 1.24-1.30).

What question did this study set out to answer?

This analysis aims to identify risk factors and develop a predictive model for microvascular complications in youth-onset type 2 diabetes.

June 7, 2026

1136-OR: Longitudinal Time-to-Event Modeling and Identification of Risk Factors for the Occurrence of Microvascular Complications in Youth-Onset Type 2 Diabetes

Q: What does this research mean for the field?

Higher baseline ALT and HbA1c, along with early increases in BMI, urine albumin-to-creatinine ratio, and systolic blood pressure, are significant predictors of microvascular complications in youth-onset type 2 diabetes, enabling accurate parametric survival modeling. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

In youth-onset type 2 diabetes, the risk of microvascular complications increased by 27% per 1% increase in baseline HbA1c (95% CI 1.24-1.30) and by 9.2% per 10 U/L increase in ALT.

Key Points

This analysis aims to identify risk factors and develop a predictive model for microvascular complications in youth-onset type 2 diabetes.
Analyzed data from 677 participants in the TODAY clinical trial with median 6-year follow-up.
Assessed baseline characteristics and clinical pharmacologic variables affecting microvascular complications.
Developed a parametric model for survival prediction using these risk factors.
9.2% increase in risk of microvascular complications per 10 U/L increase in ALT (95% CI, 1.07-1.11).
27% increase in risk per 1% increase in HbA1c (95% CI, 1.24-1.30).
Higher BMI, urine albumin to creatinine ratio, systolic blood pressure, and HbA1c changes at follow-up predicted increased risk.

Study Design

Type

Observational (n=677)

Structured PICO

Population

677 participants with youth-onset type 2 diabetes from the TODAY clinical trial, followed for a median of 6 years.

Outcome

Occurrence of microvascular complications (nephropathy, neuropathy, and retinopathy)composite

A parametric model identified baseline ALT and HbA1c, as well as early changes in BMI, blood pressure, and HbA1c, as key predictors of microvascular complications in youth-onset type 2 diabetes.

Main Result

Hazard Ratio: 1.27 (95% CI 1.24–1.3)

Abstract

Introduction and Objective: Youth-onset type 2 diabetes (T2D) is associated with an aggressive disease course and high burden of microvascular complications. The objective of this analysis was to identify risk factors and develop a predictive parametric model for the occurrence of microvascular complications in youth-onset T2D. Methods: We used data from 677 participants in the TODAY clinical trial with long term follow-up data (median 6-year) for parametric modeling. The baseline characteristics and the clinical pharmacologic variables were assessed to determine the features affecting the risk of the microvascular complications (nephropathy, neuropathy, and retinopathy). Results: At baseline, risk of microvascular complications increased by 9.2% increase per 10 U/L ALT increase (95% CI, 1.07-1.11) and 27% increase per 1% HbA1c increase (95% CI, 1.24-1.30). Higher BMI and urine albumin to creatinine ratio at 6 months, higher systolic blood pressure and HbA1c change at 12 months also predicted a higher risk. The final parametric model provided accurate survival prediction consistent with the observed Kaplan-Meier curve by baseline risk groups (figure). Conclusion: The developed parametric model including baseline characteristics and clinical pharmacologic variables provides a foundational prediction tool and will be utilized within a digital twin framework of youth-onset T2D management. Disclosure S. Hwang: None. E. Yang: None. X. Luu: None. M.L. Tanenbaum: Speaker's Bureau; Current; Beta Bionics, Inc. Other - Honoraria; Ended; Sanofi. P. Phillips: None. S. Srinivasan: Research Support; Current; Abbott, Eli Lilly and Company. R. Savic: None. Funding American Diabetes Association (7-24-ICTST2DY-05)

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