Laura Pyle and Megan M. Kelsey
The incidence of youth-onset type 2 diabetes is increasing globally. This condition carries a high burden of complications and comorbidities, as well as increased mortality. In this issue, Pyle and Kelsey (https://doi.org/10.1007/s00125-021-05480-w) summarise findings from clinical trials and large-scale prospective epidemiological studies, mainly conducted in the USA, regarding the progression and treatment of youth-onset type 2 diabetes. They discuss how youth-onset type 2 diabetes is characterised by a high degree of heterogeneity, with some youth rapidly losing glycaemic control and others maintaining good control over longer periods of time. In general, studied treatments have resulted in inadequate glycaemic control and failed to prevent the development of complications. The authors suggest that newer treatments, such as sodium–glucose cotransporter 2 (SGLT2)-inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and bariatric surgery, should be further studied in youth with type 2 diabetes, and that treatment strategies need to address the high prevalence of psychological comorbidities. They also state that innovative study designs are required to provide opportunities for the development and optimisation of personalised, multicomponent and biobehavioural interventions for youth-onset type 2 diabetes. The figure from this review is available as a downloadable slide.