Abstarct:

Introduction and Objective: Early-onset type 2 diabetes (T2D) is associated with a more adverse cardiometabolic profile and increased cardiovascular (CV) risk. We aimed to characterize cardiovascular risk and subclinical atherosclerosis in young adults with type 2 diabetes (T2D) participating in the YOUNG DIABETES program.

Methods: Observational study including individuals with type 2 diabetes (T2D) diagnosed at ≤50 years and current age ≤55 years enrolled in the YOUNG DIABETES clinical program. Participants underwent clinical and biochemical assessment, cardiovascular (CV) risk estimation (SCORE2-Diabetes), and carotid ultrasound to detect subclinical atherosclerosis.

Results: A total of 179 participants were included; 37% were women. Median age was 45 years [37-50] and diabetes duration 4 years [1-10]. Active smoking was present in 18% and 25% were former smokers. Median Body Mass Index (BMI) was 30.1 kg/m² [26.5-34.3], Median Glycated Hemoglobin (HbA1c) 7.2% [6.4-8.6], Median Low-Density Lipoprotein Cholesterol (LDL-C) 101 mg/dL [86-125.3], and calculated cardiovascular (CV) risk by SCORE2-Diabetes 5.2% [3.9-7].Carotid ultrasound was performed in 115 participants and identified subclinical atherosclerosis in 31% (20% had 1-2 plaques and 11% ≥3 plaques). Individuals with atherosclerosis were older (49 vs 42.5 years-old, p=0.0001), had longer diabetes duration (8 vs 2.5 years, p=0.0007), and higher HbA1c levels (7.9 vs 7%, p=0.03), No differences were observed by sex, smoking status, Body Mass Index (BMI), lipid profile, or calculated cardiovascular (CV) risk. In multivariate analysis, diabetes duration (OR 1.09 [1.01-1.17] and smoking exposure (OR 1.04 [1.00-1.07]) were independently associated with greater plaque burden.

Conclusion: In young adults with type 2 diabetes (T2D), in which SCORE2-Diabetes may underestimate cardiovascular risk, the YOUNG DIABETES program enables comprehensivecardiovascular risk stratification including detection of subclinical atherosclerosis. Carotid plaques were independently associated with longer diabetes duration and smoking exposure, highlighting the importance of early and strict glycemic control and smoking avoidance to reduce cardiovascular risk in young-onset type 2 diabetes (T2D).