Higher Complications, Comorbidities in Youth With Type 2 Versus Type 1 Diabetes

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The data support early complication monitoring of young patients with diabetes. <i>Image credit: Clinical Photography, Central Manchester University Hospitals NHS Foundation Trust/ Science Source</i>
The data support early complication monitoring of young patients with diabetes. Image credit: Clinical Photography, Central Manchester University Hospitals NHS Foundation Trust/ Science Source

In a cohort of young adults diagnosed with diabetes in childhood and adolescence, complications and comorbidities were increased for those with type 2 vs type 1 diabetes, according to research recently published in JAMA.

The observational study was conducted between 2002 and 2015 in 5 locations in the United States. Researchers enrolled 2018 patients with type 1 and type 2 diabetes who were diagnosed at <20 years of age. 

Single outcome measures including diabetic kidney disease, arterial stiffness, hypertension, peripheral neuropathy, and cardiovascular autonomic neuropathy were obtained from 2011 and 2015.

According to study methodology, exposures included type 1 and type 2 diabetes and established risk factors such as hemoglobin A1c level, body mass index, waist-height ratio, and mean arterial blood pressure.

"The current data, coupled with previous work, suggest that the participants in this analysis are reasonably representative of the general US population with onset of type 1 and type 2 diabetes in childhood or adolescence," the researchers wrote.

A total of 1746 patients with type 1 diabetes (mean age, 17.9 years; 76.0% non-Hispanic white; 49.7% female) and 272 patients with type 2 diabetes (mean age, 22.1 years; 26.5% non-Hispanic white; 66.5% female) were enrolled into the study. For both groups, mean diabetes disease duration was 7.9 years.

Compared with patients with type 1 diabetes, those patients with type 2 diabetes had a higher age-adjusted rate of arterial stiffness (P <.001), diabetic kidney disease (P <.001), hypertension (P <.001), peripheral neuropathy (P <.001), and retinopathy (P =.02), but a similar rate of cardiovascular autonomic neuropathy (P =.62).

After adjustment for established risk factors measured over time, type 2 diabetes was associated with a significantly increased risk for diabetic kidney disease (P =.003), retinopathy (P =.02), and peripheral neuropathy (P =.001) compared with type 1 diabetes; however, there were no significant differences between groups in arterial stiffness (P =.80), cardiovascular autonomic neuropathy (P =.93), and hypertension (P =.55).

"Among teenagers and young adults who had been diagnosed with diabetes during childhood or adolescence, the prevalence of complications and comorbidities was higher among those with type 2 diabetes compared with type 1, but frequent in both groups," the researchers concluded. "These findings support early monitoring of youth with diabetes for development of complications."

Important study limitations to note include the use of a single measure of each outcome and the possibility that patients with type 2 diabetes were exposed to longer periods of undiagnosed hyperglycemia compared with those with type 1 diabetes.

Disclosures

One study researcher reports receiving consulting fees from Denka Seiken and MedTest DX. The other researchers report no relevant financial disclosures

Reference

Dabelea D, Stafford JM, Mayer-Davis EJ. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. . JAMA. 2017;317(8):825-835. doi: 10.1001/jama.2017.0686.

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