Earlier onset of complications in youth with type 2 diabetes

  1. Elizabeth A. Sellers, MD MSc1
  1. 1Department of Pediatrics and Child Health 840 Sherbrook St. Winnipeg, MB R3A1S1.
  2. 2Department of Community Health Sciences (Manitoba Centre for Health Policy) 408-727 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 3P5.
  3. 3Department of Internal Medicine, 2300 McPhillips Street Winnipeg, Manitoba R2V 3M3.
  1. Corresponding Author: Dr. Allison Dart, Email: adart{at}hsc.mb.ca

Abstract

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). Significant adverse clinical factors included age at diagnosis (HR 1.08; 95% CI 1.02-2.12), HbA1c (HR 1.06; 95% CI 1.01-1.12) and, surprisingly, renin angiotensin aldosterone system (RAAS) inhibitor use (HR 1.75; 95% CI 1.27-2.41). HNF-1α G319S polymorphism was protective in the type 2 diabetes cohort (HR 0.58; 95% CI 0.34-0.99). Kaplan Meier statistics revealed an earlier diagnosis of renal and neurological complications in the type 2 diabetes cohort, manifesting within 5 years of diagnosis. No difference in retinopathy was seen. Cardiovascular and cerebrovascular diseases were rare however major complications (dialysis, blindness or amputation) started to manifest 10 years after diagnosis in the type 2 diabetes cohort. Youth with type 2 diabetes had higher rates of all outcomes than non-diabetes controls, and an overall 6.15 fold increased risk of any vascular disease.

Conclusions Youth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes. Younger age at diagnosis is potentially protective, and glycemic control is an important modifiable risk factor. The unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication; however, further evaluation in young people is warranted.

  • Received April 22, 2013.
  • Accepted October 8, 2013.

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  1. Diabetes Care
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