The Shift from T1 to T2 in the Youth Population

Is diagnosis of type 2 more dangerous in youth?…

T1DM used to be primarily diagnosed at a younger age and T2DM was typically found in the older population. In today’s world, there is an increasing incidence and prevalence of T2DM in younger patients as well. The Finnish Diabetic Neuropathy Study found that increased mortality was linked to increased micro- and macro-albuminuria. The previous outlook for someone diagnosed with T1DM at the age of 10 was typically 19 years less than that of a child undiagnosed. Mortality has decreased thanks to the delay/reduction of end stage renal disease. However; the number one cause of death in diabetes is cardiovascular disease (CVD) and research shows that early onset T2DM have increased risk of CVD.

Previous studies like The Search for Diabetes in Youth (SEARCH) determined that the cardiovascular risk profiles like high blood pressure, increased lipids and micro-albuminuria were higher in youth-onset T2DM compared to T1DM. The Treatment Options for Type 2 Diabetes in Adolescent and Youth (TODAY) study examined the treatments for T2 and showed how difficult it was to reach optimal glycemic control in younger patients. While T2DM in youth is still a new thing and more research is needed, these studies show a poor prognosis.

A more recently published study compares the young onset outcomes and survival rates in both type 1 and type 2. Using the Royal Prince Alfred Hospital Diabetes Database that dates back to 1986, researchers reviewed 24,415 records that documented clinical characteristics, cardiovascular risk factors, and presence of diabetes complications. Results showed that young onset T2DM patients had unfavorable cardiovascular risk including higher blood pressure, triglycerides, and albuminuria and lower HDL. There was also increased macrovascular disease, 14.4% vs. 5.75% in T2 youth. Prevalence of ischemic heart disease was 13% in type 2 versus 3% in T1. Stroke was 4.3% in T2 compared to 0.7% in T1. There were 39 fatalities out of 354 T2 patients (11%) and 32 T1 fatalities out 470 T1 patients (6.8%). The primary cause of death in both groups was cardiovascular related, but a higher hazard ratio in T2DM.

While several decades of data are still needed to truly assess an increased mortality rate, we can still see an increased cardiovascular risk and an increase in other diabetes complications.

Practice Pearls:

• "Young-onset T2DM diabetes is the more lethal phenotype of diabetes associated with greater mortality, complications, and unfavorable cardiovascular risk factors compared to T1DM"
• T2DM has high risks, and it requires intensive intervention towards glycemic control and cardiovascular risk factors.
• More focus needs to be directed towards diabetes prevention in youth.

Constantino, M. et al. Long-Term Complications and Mortality in Young-Onset Diabetes. Diabetes Care 36(12):3863-3869; 2013

Orchard, T. The Changing Face of Young-Onset Diabetes: Type 1 Optimism Mellowed by Type 2 Concerns (Commentary). Diabetes Care 36(12):3857-3859; 2013