Maternal Diabetes in Youth-Onset Type 2 Diabetes Is Associated with Progressive Dysglycemia and Risk of Complications

Document Type

Journal Article

Publication Date



The Journal of clinical endocrinology and metabolism




dysglycemia; heart rate variability; hyperfiltration; maternal diabetes; type 2 diabetes; youth


OBJECTIVE: Prenatal exposures, including undernutrition, overnutrition, and parental diabetes, are recognized risk factors for future cardiometabolic disease. There are currently no data on effects of parental diabetes on disease progression or complications in youth-onset type 2 diabetes (T2D). We analyzed effects of parental diabetes history on glycemic outcomes, β-cell function, and complications in a U.S. cohort of youth-onset T2D. METHODS: Participants (N = 699) aged 10-17 years with T2D were enrolled at 15 U.S. centers and followed for up to 12 years as part of the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) and TODAY2 follow-up studies. Information about diabetes diagnosis in biological mothers was available for 621 participants (Never =301; Before or during pregnancy = 218; After pregnancy = 102) and in biological fathers for 519 (No diabetes = 352; Paternal diabetes = 167). RESULTS: Maternal, but not paternal, diabetes was associated with loss of glycemic control over time, defined as HbA1c ≥ 8% for over 6 months (p = 0.001). Similarly, maternal, but not paternal, diabetes was associated with increased risk of glomerular hyperfiltration (p = 0.01) and low heart rate variability (p = 0.006) after 12 years of follow-up. Effects were largely independent of age, sex, race/ethnicity, and household income. Maternal diabetes during vs. after pregnancy had similar effects on outcomes. CONCLUSIONS: Maternal diabetes, regardless of whether diagnosed during vs. after pregnancy, is associated with worse glycemic control, glomerular hyperfiltration, and reduced heart rate variability in youth with T2D in TODAY. The strong associations of diabetes outcomes with maternal diabetes suggests a possible role for in utero programming.


Biostatistics and Bioinformatics