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Type 2 Youths Get Earlier Onset of Complications than Type 1’s

Nov 8, 2013
 

The onset of diabetes complications appear much earlier in youth with….

Researchers evaluated the risk of complications in youth with type two diabetes. Population based cohorts of 342 youth (1-18 yrs) with type 2 diabetes, 1011 youth with type 1 diabetes and 1710 non-diabetes controls were identified from a clinical registry and were linked to healthcare records to assess long-term outcomes utilizing ICD codes. The median follow-up times were 4.4 years for youth with type 2 diabetes, 6.7 years for youth with type 1 diabetes, and 6.0 years for nondiabetic controls.

The researchers found that youth with type 2 diabetes had a 47% increased risk of any complication than youth with type 1 diabetes. The youth with type 2 diabetes had a 6.15-fold higher risk of developing any vascular disease, a 6.26-fold higher risk of developing any microvascular disease, and a 4.44-fold higher risk of developing any macrovascular disease. The youth with type 2 diabetes also had an earlier diagnosis of renal and neurological complications that manifested within 5 years of diagnosis. Major complications (dialysis, blindness, and amputations) were rare in youth with type 1 diabetes, but they occurred in 1.1% of youth with type 2 diabetes at 10 years, 26.0% at 15 years, and 47.9% at 20 years after diagnosis. Cardiovascular and cerebrovascular diseases were rare and no difference in retinopathy was seen.

Significant adverse clinical factors included age at diagnosis and, surprisingly, renin angiotensin aldosterone system. However, the authors state that the unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication. Patients with the HNF-1α G319S polymorphism showed extra protective effects against diabetes complications in the type 2 diabetes cohort. Based on these findings, the authors conclude that youth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes.

Practice Pearls:
  • The youth with type 2 diabetes had an earlier diagnosis of renal and neurological complications that manifested within 5 years of diagnosis.
  • Youth with type 2 diabetes had a 47% increased risk of any complication than youth with type 1 diabetes.
  • No difference in retinopathy was seen between the two groups.

Diabetes Care, October 2013