Trends of the Burden of Type 2 Diabetes Mellitus Attributable to High Body Mass Index, Hypertension, Dyslipidemia in Fertile Age Group (20-44 Years) in Bulgaria

Surprisingly, many researchers have noted an increase in the prevalence of type 2 diabetes (T2D) in people between the ages of 20 and 40 (Young Adult-Onset Type 2 Diabetes). <i>Aim</i>: To provide a more accurate picture of the real health status of the young fertile population (20-44 years) in the country, by assessing the incidence of diabetes among them and examining the role of classic risk factors for diabetes/prediabetes (obesity/overweight, arterial hypertension, impaired serum lipid levels). <i>Material and Methods:</i> 936 subjects were distributed into three age groups: 20-44 years - 342 (36.5%), 45-59 years - 301 (32.2%) and 60-79 years - 293 (31.3%). Diabetes status was defined according to the criteria of the WHO/IDF Report’2016 and the data were evaluated according to age and gender. Standard OGTT (oral glucose tolerance test) was performed with measurement of plasma glucose and HbA1c was also examined. Height and weight were measured, BMI (kg/m<sup>2</sup>) was calculated. Arterial hypertension (AH) was defined according to the IDF consensus (2012) for T2D recommending arterial pressure levels up to 130/80 mmHg and the same recommendation in the last Guideline of European Society of Hypertension (ESH’2023). <i>Results: </i>In the young fertile age group (20-44 years) the incidence of diabetes/prediabetes is 14.4% (49/340), and the incidence of risk factors in them is: obesity and overweight are present in 56% (191/340); 85.7% (12/14) of young diabetics have BMI ≥ 25 kg/m<sup>2</sup>; AH is nearly 17% (57/342) among individuals in the young group; almost 1/5 of young men have AH; in 42.9% (6/14) there is a combination of AH and diabetes versus 12.9% (38/293) with AH only; the highest incidence of low serum HDL-cholesterol level (67.5%) is in the young age group; in 1/5 of them hypertriglyceridemia is present. <i>Conclusion</i>: It is necessary to develop strategies for the prevention of diabetes, which should be aimed at controlling the trend of increasing obesity/overweight, timely diagnosis and adequate treatment of AH, control of lipid levels. The increase in the incidence of diabetes in the young age group (20-44 years) means an increase in fertility problems, the course and completion of pregnancy. These are very serious health complications that require early diagnosis, but the main thing is prevention. It is necessary to introduce educational programs among the population, which should be informed about the need for lifestyle changes (nutritional habits and physical activity), personal concern and systematic care for one's own healt.