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Upstate researchers find young adults with type 2 diabetes don’t take medications as directed, leading to significant health issues

A new study by Upstate Medical University doctors shows that young adults with type 2 diabetes don’t take their blood pressure and cholesterol medicine as they should, which may explain earlier findings of early onset of serious health problems and portends worsening medical conditions as they age.

The study, “Antihypertensive and Lipid-Lowering Medication Adherence in Young Adults With Youth-Onset Type 2 Diabetes,” is published in the October issue of the JAMA Network.

Authors Ruth S. Weinstock, MD, PhD and Paula M. Trief, PhD, both SUNY Distinguished Service Professors, found that more than 80 percent of participants with hypertension did not take blood pressure medicines as needed, and 94 percent of those with high lipids did not take statins to control cholesterol. Both hypertension and high cholesterol levels, as well as having diabetes, are risk factors for developing heart disease and stroke. Factors that predicted not taking these medications included concerns about taking medicines and unmet social needs.

“Type 2 diabetes that has developed in youth is associated with very early development of hypertension, kidney disease, eye disease and other serious complications that impair quality of life and can lead to early mortality,” said Weinstock, medical director of the Clinical Research Unit and Joslin Diabetes Center. “We need to take time to address beliefs about taking medications as well as unmet social needs in these young adults with youth-onset diabetes to prevent early kidney failure and cardiovascular disease.”  

Trief said results from a previous study she did with Weinstock about adherence to oral diabetes medications also showed poor numbers, but none this low. That study showed 65 percent didn’t take their oral diabetes medicines as recommended.

“I wasn’t surprised at the blood pressure medicine and statin findings that much because we already had the oral medication finding,” Trief said. “Overall, though, I was surprised that adherence was that much worse. And I assumed the blood pressure and the statins medication would be the same because you would think people would take them together.”

Trief said the study was aimed at young or emerging adults, people aged 18 to 32, who had participated in a previous intervention study, when they were diagnosed with type 2 diabetes as children and adolescents. Once a disease mostly affecting older people, type 2 diabetes is being called an epidemic among children and young adults.

“What’s happening is, in part, because obesity is increasing in the younger population, they’re getting diabetes and since they’re getting it much earlier, they have a long lifetime with complications,” she said. “They’ve having much earlier onset of complications, higher rates, and  more severe complications.”

Trief said that about one-third of American youth are overweight, a problem closely related to the increase in kids being diagnosed with type 2 diabetes, some as young as 10 years old. The incidence of youth-onset type 2 diabetes has increased in parallel with the rise in the number of children with obesity in the United States. Associated diseases progress more rapidly in youth-onset type 2 diabetes than in adult-onset diabetes. Compared to older adults, this population shows more hypertension and cholesterol, and higher rates of kidney, retinal and nerve disease

“This isn’t just a problem for them, it’s a public health problem as our healthcare system will have to provide care to this group of highly vulnerable and sick young adults as they age,” Trief said.

Trief said the medical community needs to figure out interventions to improve medicine adherence in this age group.

“Now, type 2 diabetes is being diagnosed earlier and with associated severe health problems,” Trief said. “These young men and women are really vulnerable to really bad health at a very young age. We need to figure out how to help them.”

Caption: Study authors Ruth Weinstock, MD, PhD, and Paula Trief, PhD, say the medical community needs to find ways to improve medicine adherence rates in young adults.