In the Journals Plus

Comorbidities, complications higher in type 2 diabetes vs. type 1 diabetes

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March 1, 2017

The prevalence of comorbidities and complications is higher among adolescents and young adults with type 2 diabetes compared with adolescents and young adults with type 1 diabetes, according to findings published in JAMA.

“Providers should be aware that complications and comorbidities may already be present at young ages and relatively short duration and promote aggressive risk factor control in all adolescents and young adults with diabetes, and especially among those with type 2 diabetes and in minority youth with any type of diabetes,” Dana Dabelea, MD, PhD, professor of epidemiology and pediatrics, department of epidemiology, Colorado School of Public Health, told Endocrine Today. “That means several things: adhering to [American Diabetes Association] guidelines on frequency of HbA1c, eye examinations, lipid level, microalbuminuria and blood pressure measurements; monitoring closely the diabetes medications (insulin regimens, oral hypoglycemic drugs, etc) and make the necessary changes to ensure optimal glucose control; starting lipid-lowering and antihypertensive treatment at younger ages in needed; and advising on weight loss and weight maintenances, primarily through lifestyle approaches.”

Dana Dabelea
Dana Dabelea

Dabelea and colleagues evaluated data from the SEARCH for Diabetes in Youth registry on 2,018 adolescents and young adults diagnosed with diabetes before age 20 years to determine the prevalence and risk factors for complications related to type 1 and type 2 diabetes.

Diagnosis information was gathered between 2002 and 2015 and outcome measures were collected between 2011 and 2015. At the outcome visit, duration of diabetes was 7.9 years for both groups.

Participants with type 2 diabetes were older at diagnosis (mean age, 14.2 years) compared with participants with type 1 diabetes (mean age, 10 years) and at the outcome visit (mean age, 22.1 years vs. 17.9 years).

Participants with type 2 diabetes had significantly higher measures of obesity and mean arterial pressure. Overall, prevalence of complications and comorbidities was higher in participants with type 2 diabetes compared with participants with type 1 diabetes.

The prevalence of diabetic kidney disease was higher among participants with type 2 diabetes (19.9%) compared with participants with type 1 diabetes (5.8%; P < .001). Compared with participants with type 1 diabetes, participants with type 2 diabetes had a higher prevalence of diabetic retinopathy (P = .02), peripheral neuropathy (P < .001), arterial stiffness (P < .001) and hypertension (P < .001).

“The study found that the prevalence of diabetes-related complications and comorbidities was high in both diabetes types at a young age and after less than 8 years’ duration of diabetes,” Dabelea said. “The most disturbing result was that this burden disproportionately affected youth with type 2 diabetes and minority youth. Approximately one in three teenagers and young adults with type 1 diabetes (32%) and almost three of four of those with type 2 diabetes (72%) had at least one such complication. Additionally, adjustment for differences in age, sex, race/ethnicity and levels of glucose control over time did not remove the excess prevalence among those with type 2 diabetes.” – by Amber Cox

For more information:

Dana Dabelea, MD, PhD, can be reached at University of Colorado Anschutz Medical Campus, 13001 E. 17th Ave., Box B119, Room W3110, CO 80045; email: dana.dabelea@ucdenver.edu.

Disclosure: Dabelea reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.