Format

Send to

Choose Destination
Lancet Child Adolesc Health. 2018 Nov 5. pii: S2352-4642(18)30309-2. doi: 10.1016/S2352-4642(18)30309-2. [Epub ahead of print]

Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes: an observational cohort study.

Author information

1
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: katherine.sauder@ucdenver.edu.
2
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
3
Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
4
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
5
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
6
Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
7
Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
8
Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
9
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
10
Department of Pediatrics, University of Washington, Seattle, WA, USA.
11
Northwest Lipid Research Laboratory, University of Washington, Seattle, WA, USA.
12
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.

Abstract

BACKGROUND:

One in three adolescents and young adults with type 1 diabetes have at least one early diabetes-related complication or comorbidity. We aimed to examine the prevalence and pattern of co-occurring complications in this population, as well as the related risk factors.

METHODS:

This observational cohort study includes data from individuals diagnosed with type 1 diabetes before age 20 years who participated in the SEARCH for Diabetes in Youth Study across five sites in the USA. We assessed sociodemographic and metabolic risk factors at baseline and at follow-up, and diabetes complications at follow-up. A frequency analysis was done to examine the difference in observed versus expected prevalence (calculated using a contingency table assuming independence across cells) of co-occurring complications or comorbidities. A cluster analysis was done to identify unique clusters of participants based on demographic characteristics and metabolic risk factors.

FINDINGS:

1327 participants who completed the follow-up visit were included in the frequency analysis. The mean age was 10·1 (SD 3·9) years at the time of type 1 diabetes diagnosis and 18·0 (4·1) years at follow-up. At a mean diabetes duration of 7·8 [SD 1·9] years, co-occurrence of any two or more complications was observed in 78 (5·9%) participants, more frequently than expected by chance alone (58 [4·4%], p=0·015). Specifically, the complications that co-occurred more frequently than expected were retinopathy and diabetic kidney disease (11 [0·8%] vs three [0·2%]; p=0·0007), retinopathy and arterial stiffness (13 [1·0%] vs four [0·3%]; p=0·0016), and arterial stiffness and cardiovascular autonomic neuropathy (24 [1·8%] vs 13 [1·0%]; p=0·015). We identified four unique clusters characterised by progressively worsening metabolic risk factor profiles (longer duration of diabetes and higher glycated haemoglobin, non-HDL cholesterol, and waist-to-height ratio). The prevalence of at least two complications increased across the clusters (six [2·3%] of 261 in the low-risk cluster, 32 [6·3%] of 509 in the moderate-risk cluster, 28 [8%] of 348 in the high-risk cluster, and five [20·8%] of 24 in the highest-risk cluster). Compared with the low-risk and moderate-risk clusters, the high-risk and highest-risk clusters were characterised by a lower proportion of participants who were non-Hispanic white, and a higher proportion of participants who had a household income below US$50 000 and did not have private health insurance.

INTERPRETATION:

Early complications co-occur in adolescents and young adults with type 1 diabetes more frequently than expected. Identification of individuals with adverse risk factors could enable targeted behavioural or medical interventions that reduce the likelihood of early development of lifelong diabetes-related morbidity.

FUNDING:

US Centers for Disease Control and Prevention, US National Institutes of Health.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center