Incidence of Retinopathy and Nephropathy in Youth-Onset Compared With Adult-Onset Type 2 Diabetes

  1. Jonathan Krakoff, MD,
  2. Robert S. Lindsay, MB, PHD,
  3. Helen C. Looker, MB,
  4. Robert G. Nelson, MD, PHD,
  5. Robert L. Hanson, MD, MPH and
  6. William C. Knowler, MD, DRPH
  1. From the National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona


    OBJECTIVE—To examine the risk of retinopathy and nephropathy in participants in whom type 2 diabetes was diagnosed in youth (before 20 years of age) compared with those in whom type 2 diabetes was diagnosed at older ages.

    RESEARCH DESIGN AND METHODS—Subjects in whom youth-onset or adult-onset diabetes was diagnosed in the longitudinal study of health in the Pima Indians of Arizona were followed for microvascular complications. Diabetes was diagnosed in 178 subjects before 20 years of age (youth), in 1,359 subjects at 20–39 years of age (younger adults), and in 971 subjects at 40–59 years of age (older adults). Incidence rates of diabetic retinopathy diagnosed by direct ophthalmoscopy through dilated pupils and nephropathy (protein-to-creatinine ratio ≥0.5 g/g) were calculated by age at diagnosis.

    RESULTS—Over 25 years, nephropathy developed in 35 of the participants with youth-onset type 2 diabetes; this incidence rate was not significantly different from that in patients with adult-onset diabetes (P = 0.77). Incidence rates of retinopathy, however, were significantly lower for the youth-onset group (P = 0.007). Adjusted for sex, glycemia, and blood pressure, risk of retinopathy was lower in patients with youth-onset diabetes than in those with adult-onset diabetes (hazard rate ratio [HRR] 0.42, 95% CI 0.24–0.74, P = 0.003), but risk of nephropathy was not different (HRR 1.2, 95% CI 0.77–1.3, P = 0.38).

    CONCLUSIONS—In Pima Indians, the risk of nephropathy as a function of duration of diabetes is similar in all age groups. By contrast, the risk of retinopathy is lower in patients with youth-onset type 2 diabetes.


    • Address correspondence to Jonathan Krakoff, MD, Diabetes and Arthritis Epidemiology Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 1550 East Indian School Rd., Phoenix, AZ 85014. E-mail: jkrakoff{at}

      Received for publication 22 July 2002 and accepted in revised form 24 September 2002.

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