Adolescents with childhood-onset type 2 diabetes prone to complications
Teenagers and young adults diagnosed with type 2 diabetes in childhood or adolescence have a higher risk of complications and comorbidities compared with those diagnosed with type 1 diabetes, an observational US study found.
“At an estimated age of 21 years and after 7.9 years’ mean diabetes duration, approximately one in three teenagers and young adults with type 1 diabetes (32 percent) and almost three of four of those with type 2 diabetes (72 percent) had at least one such complication or comorbidity, and these rates are likely to increase,” said the researchers.
After adjusting for established risk factors (haemoglobin A1c level, body mass index, waist-height ratio, and mean arterial blood pressure), teenagers and young adults who were diagnosed with type 2 diabetes before age 20 had a higher risk of developing diabetic kidney disease (adjusted odds ratio [adjOR], 2.58, 95 percent confidence interval [CI], 1.39–4.81; p=0.003) and peripheral neuropathy (adjOR, 2.52, 95 percent CI, 1.43–4.43; p=0.001) compared with those diagnosed with type 1 diabetes in childhood. [JAMA 2017;317:825-835]
Teenagers and young adults diagnosed with type 2 diabetes in childhood also had a higher risk of retinopathy (adjOR, 2.24, 95 percent CI, 1.11–4.50; p=0.02) compared with those diagnosed with type 1 diabetes.
The risk for hypertension, arterial stiffness, and cardiovascular autonomic neuropathy was similar among teenagers and young adults with type 1 and type 2 diabetes (adjOR, 0.85, 95 percent CI, 0.50–1.45; p=0.55 for hypertension, adjOR, 1.07, 95 percent CI, 0.63–1.84; p=0.80 for arterial stiffness, and adjOR, 0.98, 95 percent CI, 0.57–1.67; p=0.93 for cardiovascular autonomic neuropathy).
Subjects in the SEARCH for Diabetes in Youth registry study were 2,018 teenagers and young adults diagnosed with type 1 (n=1,746, mean age, 17.9 years, 49.7 percent female) or type 2 diabetes (n=272, mean age, 22.1 years, 66.5 percent female).
“In this cohort of teenagers and young adults who had received a diagnosis of diabetes during childhood and adolescence, the prevalence of diabetes-related complications was higher among those with type 2 diabetes than with type 1, but the prevalence was substantial in both groups,” said the researchers.
“Given that cardiovascular disease and mortality have been shown to be higher in young-onset type 2 diabetes than in young-onset type 1 diabetes, as well as in young-onset vs later-onset type 2 diabetes, the presence of arterial stiffness and hypertension at a young age, together with an increased prevalence of risk factors and diabetic kidney disease, suggests that these patients may be at increased risk for subsequent cardiovascular events,” they said.
The researchers indicated the possibility that microvascular complications may be more aggressive among adolescents and young adults with type 2 diabetes compared with type 1 diabetes, a theory that incidence data may help to determine. They also recommended looking into other potential pathways including inflammatory markers, dietary factors, endothelial dysfunction, and advanced glycation end products, and highlighted the importance of early monitoring of patients with either type of diabetes in detecting potential complications.