Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood
Authors: Dana Dabelea, Jeanette M. Stafford, Elizabeth J. Mayer-Davis, Ralph D’Agostino, Lawrence Dolan, Giuseppina Imperatore, Barbara Linder, Jean M. Lawrence, Santica M. Marcovina, Amy K. Mottl, Mary Helen Black, Rodica Pop-Busui, Sharon Saydah, Richard F. Hamman, Catherine Pihoker
Journal: JAMA (2017)

<h3>Importance</h3> The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Type 1 and type 2 diabetes and established risk factors (hemoglobin A<sub>1c</sub>level, body mass index, waist-height ratio, and mean arterial blood pressure). <h3>Main Outcomes and Measures</h3> Diabetic kidney disease, retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, arterial stiffness, and hypertension. <h3>Results</h3> 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%;<i>P</i> &lt; .001), retinopathy (9.1% vs 5.6%; AD, 3.5%; 95% CI, 0.4%-7.7%;<i>P</i> = .02), peripheral neuropathy (17.7% vs 8.5%; AD, 9.2%; 95% CI, 4.8%-14.4%;<i>P</i> &lt; .001), arterial stiffness (47.4% vs 11.6%; AD, 35.9%; 95% CI, 29%-42.9%;<i>P</i> &lt; .001), and hypertension (21.6% vs 10.1%; AD, 11.5%; 95% CI, 6.8%-16.9%;<i>P</i> &lt; .001), but not cardiovascular autonomic neuropathy (15.7% vs 14.4%; AD, 1.2%; 95% CI, –3.1% to 6.5;<i>P</i> = .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;<i>P</i>=.003), retinopathy (OR, 2.24; 95% CI, 1.11-4.50;<i>P</i> = .02), and peripheral neuropathy (OR, 2.52; 95% CI, 1.43-4.43;<i>P</i> = .001), but no significant difference in the odds of arterial stiffness (OR, 1.07; 95% CI, 0.63-1.84;<i>P</i> = .80) and hypertension (OR, 0.85; 95% CI, 0.50-1.45;<i>P</i> = .55). <h3>Conclusions and Relevance</h3> 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.