Reuters Health Oct 29 – In youth with diabetes, complications develop earlier and more often with type 2 disease than with type 1, researchers from Canada report.
”As type 1 diabetes is generally more prevalent and complications may only become evident over many years to decades clinicians might presume that the same schedule of complication monitoring holds for type 2 diabetes,” Dr. Stuart Chalew, from Children’s Hospital New Orleans, told Reuters Health by email.
”The implications of this paper are that earlier and more aggressive surveillance and intervention for complications may be needed in practice for high risk youngsters with obesity associated type 2 diabetes,” added Dr. Chalew, who was not involved in the study.
Dr. Alison B. Dart and colleagues from University of Manitoba in Winnipeg used data from Manitoba’s Diabetes Education Resource for Children and Adolescents and the Population Health Research Data Repository to investigate the time course and risk factors for microvascular and macrovascular complications in 342 youth with type 2 diabetes. They also looked at a control group of 1,011 youth with type 1 diabetes and a matched group of 1,710 youth with no diabetes.
The median follow-up times were 4.4 years for youth with type 2 diabetes, 6.7 years for youth with type 1 diabetes, and 6.0 years for nondiabetic controls. At the last available follow-up, the average age was between 15 and 16 years.
After controlling for various factors, youth with type 2 diabetes had a 47% higher risk of any complications than youth with type 1 diabetes, the authors reported October 15 online in Diabetes Care.
Compared with nondiabetic controls, the youth with type 2 diabetes had a 6.15-fold higher risk of developing any vascular disease, a 6.26-fold higher risk of developing any microvascular disease, and a 4.44-fold higher risk of developing any macrovascular disease.
They also had a 19.49-fold higher risk of ophthalmologic disease, a 16.13-fold higher risk of renal disease, a 2.93-fold higher risk of neurologic disease, and a 6.25-fold higher risk of peripheral vascular disease, compared to nondiabetic youth.
Major complications were rare in youth with type 1 diabetes, but they occurred in 1.1% of youth with type 2 diabetes at 10 years, 26.0% at 15 years, and 47.9% at 20 years after diagnosis.
Adults with type 2 diabetes typically manifest significant complications 15 to 20 years after their diagnosis, the authors say.
The presence of HNF-1 G319S polymorphism protected against complications in youth with type 2 diabetes.
”This study therefore highlights the fact that youth is not protective against the multisystem effects of type 2 diabetes, and although not directly evaluated, the time course to complications parallels that seen in adults,” the researchers conclude.
”The need for additional research in this area is obvious,” Dr. Chalew said. ”Type 2 diabetes is much more common in certain ethnic groups, e.g., Mexican-Americans, African-Americans, Native-Americans in the US. In this article, the type 2 population is enriched with patients of First Nation origin in Canada while type 1 diabetes is reported to be rare in this group. Thus ethnicity/genetics/socio-economic disparities are also likely to play a role in rapid development of complications in the population studied in this article, and potentially other ethnic populations in which precocious type 2 diabetes occurs.”
”As type 2 diabetes is intimately associated with obesity, the article reinforces the need and current ongoing efforts to prevent the development and mitigate effects of obesity in children and adolescents in order to prevent its serious comorbidities such as type 2 diabetes, hypertension, and dyslipidemia,” Dr. Chalew concluded.
Nyhetsinfo
www red DiabetologNytt