OBJECTIVE Young-onset type 2 diabetes (YOD) results from complex causes, calling for precision management. RESEARCH DESIGN AND METHODS The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM) study was a single-center, two-arm, 3-year randomized controlled trial in which Chinese individuals aged 18 to 50 years with non–type 1 diabetes diagnosed at age ≤40 years were randomly assigned to intervention (Joint Asia Diabetes Evaluation JADE–PRISM) or usual clinic-based care (JADE only). The intervention included technologically guided assessment and use of biogenetic markers (autoantibodies, C-peptide, and common and rare genetic variants) to classify diabetes for 1-year intensified, algorithm-based treatment followed by two annual reviews by an endocrinologist-led multidisciplinary team. The primary end point was a composite of incident or progression of all diabetes-related complications. Secondary end points included attainment of three or more treatment targets (HbA1c 6·2%, blood pressure 120/75 mmHg, LDL cholesterol 1.2 mmol/L, triglycerides 1.2 mmol/L, and waist circumference 80 women or 85 cm men), proxies of β-cell function, and patient-reported outcome measures (PROMs). RESULTS During 2020 to 2021, 884 participants (mean SD age 40.7 6.5 years; mean SD age at diagnosis 32.5 6.8 years; autoantibody positivity n = 46; monogenic diabetes n = 23; C-peptide 200 pmol/L n = 82; central obesity n = 699; dyslipidemia n = 669; hypertension n = 588; albuminuria n = 313; insulin treated n = 250) were randomly assigned to the JADE-PRISM (n = 441) or JADE-only group (n = 443). During the 3-year study, the primary end point developed in 116 participants (26.3%) in the JADE-PRISM group versus 125 (28.2%) in the JADE-only group (odds ratio 0.908 95% CI 0.675–1.221). In the JADE-PRISM group, 104 participants (23.8%) versus 54 in the JADE-only group (12.2%; P 0.001) reached three or more treatment targets, with improved proxies of β-cell function and reduced emotional distress. CONCLUSIONS A 3-year technology-enhanced, multicomponent program improved cardiometabolic status, proxies of β-cell function, and PROMs in individuals with YOD but did not reduce complications.
Luk et al. (2026) studied this question.