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JAMA. 2017 Feb 28;317(8):825-835. doi: 10.1001/jama.2017.0686.

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood.

Author information

1
Department of Epidemiology, Colorado School of Public Health, Aurora.
2
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
3
Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill.
4
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
6
Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
7
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
8
Northwest Lipid Research Laboratory, University of Washington, Seattle.
9
UNC Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill.
10
Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor.
11
Department of Pediatrics, University of Washington, Seattle.

Abstract

Importance:

The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown.

Objective:

To determine the prevalence of and risk factors for complications related to type 1 diabetes vs type 2 diabetes among teenagers and young adults who had been diagnosed with diabetes during childhood and adolescence.

Design, Setting, and Participants:

Observational study from 2002 to 2015 in 5 US locations, including 2018 participants with type 1 and type 2 diabetes diagnosed at younger than 20 years, with single outcome measures between 2011 and 2015.

Exposures:

Type 1 and type 2 diabetes and established risk factors (hemoglobin A1c level, body mass index, waist-height ratio, and mean arterial blood pressure).

Main Outcomes and Measures:

Diabetic kidney disease, retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, arterial stiffness, and hypertension.

Results:

Of 2018 participants, 1746 had type 1 diabetes (mean age, 17.9 years [SD, 4.1]; 1327 non-Hispanic white [76.0%]; 867 female patients [49.7%]), and 272 had type 2 (mean age, 22.1 years [SD, 3.5]; 72 non-Hispanic white [26.5%]; 181 female patients [66.5%]). Mean diabetes duration was 7.9 years (both groups). Patients with type 2 diabetes vs those with type 1 had higher age-adjusted prevalence of diabetic kidney disease (19.9% vs 5.8%; absolute difference [AD], 14.0%; 95% CI, 9.1%-19.9%; P < .001), retinopathy (9.1% vs 5.6%; AD, 3.5%; 95% CI, 0.4%-7.7%; P = .02), peripheral neuropathy (17.7% vs 8.5%; AD, 9.2%; 95% CI, 4.8%-14.4%; P < .001), arterial stiffness (47.4% vs 11.6%; AD, 35.9%; 95% CI, 29%-42.9%; P < .001), and hypertension (21.6% vs 10.1%; AD, 11.5%; 95% CI, 6.8%-16.9%; P < .001), but not cardiovascular autonomic neuropathy (15.7% vs 14.4%; AD, 1.2%; 95% CI, -3.1% to 6.5; P = .62). After adjustment for established risk factors measured over time, participants with type 2 diabetes vs those with type 1 had significantly higher odds of diabetic kidney disease (odds ratio [OR], 2.58; 95% CI, 1.39-4.81; P=.003), retinopathy (OR, 2.24; 95% CI, 1.11-4.50; P = .02), and peripheral neuropathy (OR, 2.52; 95% CI, 1.43-4.43; P = .001), but no significant difference in the odds of arterial stiffness (OR, 1.07; 95% CI, 0.63-1.84; P = .80) and hypertension (OR, 0.85; 95% CI, 0.50-1.45; P = .55).

Conclusions and Relevance:

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. These findings support early monitoring of youth with diabetes for development of complications.

PMID:
28245334
PMCID:
PMC5483855
DOI:
10.1001/jama.2017.0686
[Indexed for MEDLINE]
Free PMC Article

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