Type 2 diabetic youth more likely to develop complications
Youth below 20 with type 2 diabetes mellitus (T2DM) are more likely to develop kidney, nerve and eye complications upon adulthood than their peers with type 1 diabetes mellitus (T1DM), according to a new study.
The SEARCH* study—a long-term observational study of diabetic youth in the US enrolled between 2002 and 2015— found that among a cohort of 2,018 diabetic patients diagnosed before the age of 20, approximately three-quarters of those with T2DM had at least one complication or were at high risk of a complication by age 21, versus one-third of those with T1DM. [JAMA 2017;317(8):825–835]
"There's often the assumption that young people don't develop complications from diabetes, but that's just not true. We saw that young people with diabetes are developing signs of major complications in the prime of their lives," said Dr. Barbara Linder, study author and senior advisor for childhood diabetes research within the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Particularly for youth with type 2 DM, this research demonstrates the clear need to learn how to reduce or delay the debilitating complications of diabetes, itself a huge challenge for young people to manage."
The paper examined results from 1,746 patients with T1DM and 272 with T2DM enrolled in the course of the SEARCH study at five clinical centers, with diabetic complication outcomes measured between 2011 and 2015. On average, participants had been diagnosed with either diabetes type for 8 years by the end of the study.
Patients with T2DM had higher age-adjusted prevalences of diabetic kidney disease (19.9% vs 5.8%; 95% CI, 9.1%–19.9%; p<0.001), retinopathy (9.1% vs 5.6%; 95% CI, 0.4%–7.7%; p=0.02), peripheral neuropathy (17.7% vs 8.5%; 95% CI, 4.8%-14.4%; p<0.001), arterial stiffness (47.4% vs 11.6%; 95% CI, 29%–42.9%; p<0.001), and hypertension (21.6% vs 10.1%; 95% CI, 6.8%–16.9%; p<0.001) versus those with T1DM.
While the researchers examined potential factors that might explain the difference in complication prevalence among the two patient groups—including glucose control (hemoglobin A1c levels), body mass index, waist-to-height ratio and blood pressure—a significant difference in odds persisted for diabetic kidney disease (odds ratio [OR], 2.58; 95% CI, 1.39–4.81; p<0.003), retinopathy (OR, 2.24; 95% CI, 1.11–4.50; p<0.02), and peripheral neuropathy.
"This study highlights the need for early monitoring for development of complications among young people with diabetes," said Dr. Sharon Saydah, senior scientist at CDC and an author on the paper. "If young people can delay onset of these complications from diabetes by even a few years, it could ease their burden and lengthen their lives."
*SEARCH: SEARCH for Diabetes in Youth study