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

Published on Feb 28, 2017in JAMA51.273
· DOI :10.1001/jama.2017.0686
Dana Dabelea67
Estimated H-index: 67
(Colorado School of Public Health),
Jeanette M. Stafford18
Estimated H-index: 18
(Wake Forest University)
+ 12 AuthorsCatherine Pihoker39
Estimated H-index: 39
(UW: University of Washington)
Sources
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 A 1c 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 P  = .02), peripheral neuropathy (17.7% vs 8.5%; AD, 9.2%; 95% CI, 4.8%-14.4%; P P P 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.
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  • References (39)
  • Citations (104)
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References39
Newest
#1Abdulghani Al-Saeed (USYD: University of Sydney)H-Index: 2
#2Maria I. Constantino (USYD: University of Sydney)H-Index: 12
Last. Jencia Wong (USYD: University of Sydney)H-Index: 12
view all 10 authors...
OBJECTIVE This study compared the prevalence of complications in 354 patients with T2DM diagnosed between 15 and 30 years of age (T2DM 15–30 ) with that in a duration-matched cohort of 1,062 patients diagnosed between 40 and 50 years (T2DM 40–50 ). It also examined standardized mortality ratios (SMRs) according to diabetes age of onset in 15,238 patients covering a wider age-of-onset range. RESEARCH DESIGN AND METHODS Complication status was assessed according to a standard protocol and extracte...
44 CitationsSource
#1Petter Bjornstad (University of Colorado Denver)H-Index: 16
#2David Z.I. Cherney (U of T: University of Toronto)H-Index: 31
Last. David Maahs (CU: University of Colorado Boulder)H-Index: 49
view all 3 authors...
The American Diabetes Association recommends annual assessment of glomerular filtration rate (GFR) to screen for diabetic nephropathy. GFR is measured indirectly using markers that, ideally, are eliminated only by glomerular filtration. Measured GFR, although the gold standard, remains cumbersome and expensive. GFR is therefore routinely estimated using creatinine and/or cystatin C and clinical variables. In pediatrics, the Schwartz creatinine-based equation is most frequently used even though c...
20 CitationsSource
Background In the UK, the care of young people with diabetes has focused predominantly on type 1 diabetes (T1D). However, young-onset T2D has become increasingly prevalent. At present, it is unclear which type of diabetes represents the more adverse phenotype to develop complications. This study aims to determine the complication burden and its predictive factors in young-onset T2D compared with T1D. Methods A cross-sectional study using a hospital diabetes register to identify patients with you...
35 CitationsSource
#1Jencia Wong (USYD: University of Sydney)H-Index: 12
#2Maria I. Constantino (USYD: University of Sydney)H-Index: 12
Last. Dennis K. Yue (USYD: University of Sydney)H-Index: 47
view all 3 authors...
Increasingly, we recognise that type 2 diabetes in youth is a disease with an aggressive time course and a significant complication risk. On the other hand, outcomes for youth with type 1 diabetes appear generally to be improving. With increasing numbers of both types of diabetes in youth, it is timely that a comparative perspective is offered to help clinicians prognosticate more appropriately. Contemporary comparative studies add a new perspective to a consistent story, that for youth-onset ty...
22 CitationsSource
#1Richard F. Hamman (Colorado School of Public Health)H-Index: 82
#2Ronny A. Bell (Wake Forest University)H-Index: 49
Last. Sharon Saydah (CDC: Centers for Disease Control and Prevention)H-Index: 37
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312 CitationsSource
#1Dana Dabelea (Colorado School of Public Health)H-Index: 67
#2Elizabeth J. Mayer-Davis (UNC: University of North Carolina at Chapel Hill)H-Index: 68
Last. Richard F. Hamman (Colorado School of Public Health)H-Index: 82
view all 17 authors...
602 CitationsSource
Abstract Aim To assess the prevalence and risk factors for diabetic retinopathy (DR) in people with young onset type 1 (T1DM-Y) and type 2 diabetes (T2DM-Y). Methods T1DM-Y(n=150) and T2DM-Y(n=150) participants, age between 10 and 25 years at diagnosis, had a complete clinical evaluation, biochemical assessment, and four field digital retinal colour photography. The Early Treatment Diabetic Retinopathy Study grading system was used to grade DR. Proliferative diabetic retinopathy (PDR) and diabet...
27 CitationsSource
#1Allison DartH-Index: 14
#2Patricia J. MartensH-Index: 29
Last. Elizabeth A.C. SellersH-Index: 22
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Objective To evaluate the risk of complications in youth with type 2 diabetes. Research Design and Methods Population based cohorts of 342 prevalent youth (1-18 yrs) with type 2 diabetes, 1011 youth with type 1 diabetes and 1710 non-diabetes controls identified between 1986-2007 from a clinical registry and were linked to healthcare records to assess long-term outcomes utilizing ICD codes. Results Youth with type 2 diabetes had an increased risk of any complication (HR 1.47; 95% CI 1.02-2.12). S...
94 CitationsSource
#1Andrea O.Y. Luk (CUHK: The Chinese University of Hong Kong)H-Index: 16
#2Eric S.H. Lau (CUHK: The Chinese University of Hong Kong)H-Index: 8
Last. C N Chan Juliana (CUHK: The Chinese University of Hong Kong)H-Index: 77
view all 8 authors...
OBJECTIVE We examined metabolic profiles and cardiovascular-renal outcomes in a prospective cohort of Chinese patients with young-onset diabetes defined by diagnosis age <40 years. Patients with type 1 diabetes and normal-weight (BMI <23 kg/m2) and overweight (BMI ≥23 kg/m2) patients with type 2 diabetes were compared. RESEARCH DESIGN AND METHODS Between 1995 and 2004, 2,323 patients (type 1 diabetes, n = 209; normal-weight type 2 diabetes, n = 636; and overweight type 2 diabetes, n = 1,478) und...
49 CitationsSource
#1Angela Badaru (UW: University of Washington)H-Index: 9
#2Georgeanna J. Klingensmith (University of Colorado Denver)H-Index: 38
Last. Catherine Pihoker (UW: University of Washington)H-Index: 39
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Aims To describe treatment regimens in youth with type 2 diabetes, and examine associations between regimens, demographic and clinical characteristics, and glycemic control. Methods This report includes 474 youth with a clinical diagnosis of type 2 diabetes who completed a SEARCH for Diabetes in Youth study visit. Diabetes treatment regimen was categorized as lifestyle alone; metformin monotherapy; any oral hypoglycemic agent (OHA) other than metformin, or two or more OHAs; insulin monotherapy; ...
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Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance w...
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#1Maria Carolina Ibanez-Bruron (UCL: University College London)H-Index: 1
Last. Jugnoo S. RahiH-Index: 32
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Background We investigated the incidence and causes of sight-threatening diabetes-related eye disease in children living with diabetes in the UK, to inform the national eye screening programme and enable monitoring of trends. Methods We undertook a prospective active national surveillance via the British Ophthalmic Surveillance Unit. Eligible cases were children aged 18 years or younger, with type 1 or 2 diabetes, newly diagnosed between January 2015 and February 2017 with sight-threatening diab...
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#1Grace Kim (BCM: Baylor College of Medicine)
#2Daniel J. DeSalvo (BCM: Baylor College of Medicine)H-Index: 8
Last. Sarah K. Lyons (BCM: Baylor College of Medicine)H-Index: 5
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Background Youth onset type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing and associated with earlier vascular complications and mortality. Dyslipidemia is an important modifiable cardiovascular (CVD) risk factor that is under-recognized and undertreated in youth with T1D and T2D. Given this, we evaluated the prevalence and associations between lipid concentrations and clinical CVD risk factors in youth with T1D compared to T2D at our large ethnically diverse diabetes center. Methods ...
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#1Abby M. Walch (MCW: Medical College of Wisconsin)
#2Carmen E. Cobb (MCW: Medical College of Wisconsin)
Last. Susanne M. Cabrera (MCW: Medical College of Wisconsin)H-Index: 10
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The transition process from pediatric to adult care in individuals with T1D has long-term ramifications on health outcomes. Recognition of differences in care delivery and changes made in management during this time may improve the process. We hypothesized that pediatric providers would be less likely to address T1D-related comorbidities than their adult counterparts, highlighting opportunities to strengthen care. A retrospective chart review of patients aged 16–21 years diagnosed with T1D befor...
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#1Mark Porter (JHUSOM: Johns Hopkins University School of Medicine)
#2Roomasa Channa (Johns Hopkins University)H-Index: 19
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BACKGROUND: Diabetic retinopathy (DR) is a serious complication that can progress to sight-threatening disease. The prevalence of DR in youth with diabetes has been reported to be 3.8-20%. OBJECTIVE: We aimed to evaluate the prevalence of DR among youth with diabetes, at a large ophthalmologic referral center. Secondary goals were to determine risk factors for DR and severity of disease. METHODS: Retrospective chart review of 343 patients with diabetes 8% had a higher risk of DR (P = 0.049). In ...
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#1Madelon B. Bronner (Rotterdam University of Applied Sciences)
#1Madelon B. BronnerH-Index: 5
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#1Barbara J. Deal (NU: Northwestern University)H-Index: 42
#2Mark Daniel Huffman (NU: Northwestern University)H-Index: 32
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The prevalence of obesity among youth in the USA is currently >18% with projections that more than half of today's children will be obese as adults. The growth trajectory of children more likely to become obese is determined by weight in earliest childhood, and childhood body mass index (BMI) tracks through adolescence and adulthood. Childhood consequences of obesity include increased risk of asthma, type 2 diabetes mellitus, orthopedic disorders, and reduced academic performance. Health implica...
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#1Lynn Ang (UM: University of Michigan)H-Index: 5
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