Teens and young adults with type 2 diabetes develop more complications than those with type 1

In the years shortly after a diagnosis of type 2 diabetes, teens and young adults will experience more diabetic kidney disease, peripheral neuropathy, and retinopathy, compared with those diagnosed with type 1 diabetes, according to results from the SEARCH for Diabetes in youth study funded by the National Institutes of Health (NIH)and the Centers for Disease Control and Prevention (CDC), which was published February 28, in the Journal of the American Medical Association.

“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 Barbara Linder, MD, PhD, study co-author and senior advisor for childhood diabetes research within the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Particularly for youth with type 2, 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.”

For this observational study, Dr. Linder and colleagues included 2,018 subjects with type 1 (n=1,746; mean age: 17.9 years; 76.0% non-Hispanic white females) and type 2 diabetes (n=272; mean age: 22.1 years; 26.5% non-Hispanic white; 66.5% female) who were diagnosed before the age of 20 years between 2002 and 2015 from five locations in the United States, and gathered single outcome measures between 2011 and 2015. In both groups, the mean duration of diabetes was 7.9 years.

Researchers found that patients with type 2 diabetes had a higher age-adjusted prevalence of the following compared with those with type 1 diabetes:

• Diabetic kidney disease (19.9% vs 5.8%, respectively; absolute difference [AD]: 14.0%; 95% CI: 9.1%-19.9%; P < 0.001);
• Retinopathy (9.1% vs 5.6%; AD: 3.5%; 95% CI: 0.4%-7.7%; P=0.02);
• Peripheral neuropathy (17.7% vs 8.5%; AD: 9.2%; 95% CI: 4.8%-14.4%; P < 0.001);
• Arterial stiffness (47.4% vs 11.6%; AD: 35.9%; 95% CI: 29%-42.9%; P < 0.001); and
• Hypertension (21.6% vs 10.1%; AD: 11.5%; 95% CI: 6.8%-16.9%; P < 0.001).

Patients with type 2 diabetes did not, however, have a higher age-adjusted prevalence of cardiovascular autonomic neuropathy (15.7% vs 14.4%; AD: 1.2%; 95% CI: -3.1% to 6.5%; P=0.62).

Upon adjusting for established risk factors measured over time, Dr. Linder and fellow researchers found that subjects with type 2 diabetes had a significantly higher odds of the following compared with those with type 1 diabetes:

• Diabetic kidney disease (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 (OR: 2.52; 95% CI: 1.43-4.43; P=0.001).

No between-group differences were seen, however, in the odds of arterial stiffness (OR: 1.07; 95% CI: 0.63-1.84; P=0.80) or hypertension (OR: 0.85; 95% CI: 0.50-1.45; P=0.55).

“This study highlights the need for early monitoring for development of complications among young people with diabetes,” said co-author Sharon Saydah, PhD, senior scientist at CDC. “If young people can delay onset of these complications from diabetes by even a few years, that can ease their burden and lengthen their lives.”