Adolescents with type II diabetes have more complications than those with type I

1. In this prospective cohort, adolescents with type II diabetes (DM2) were more predisposed to almost every diabetes related complication at age 21 than those with type I diabetes (DM1).

2. When controlling for known risk factors, such as obesity and glycemic control, those with DM2 still had a higher rate of diabetic kidney disease, retinopathy, and peripheral neuropathy than those with DM1.

Evidence Rating Level: 2 (Good)

Study Rundown: The prevalence of DM1 and DM2 has been rising in pediatric populations over time. Understanding how these diseases lead to complications and comorbidities is essential. Despite their similarities, DM1 and DM2 represent distinct pathogenic mechanisms, and it is unclear whether specific environmental risk factors drive morbidity in one disease over the other. In this prospective, cross-sectional cohort analysis, adolescents from 5 major US cities with DM1 or DM2 were followed until age 21, and their rates of complications and comorbidities were recorded. While mean HbA1c were similar between groups, those with DM2 developed diabetic kidney disease, retinopathy, peripheral neuropathy, arterial stiffness, and hypertension at a greater rate than those with DM1. Cardiovascular autonomic neuropathy rates were similar between groups. In addition, those with DM2 had higher rates of obesity and elevated mean arterial pressure over time. After controlling for these multiple risk factors and others, those with DM2 still had higher rates of diabetic kidney disease, retinopathy, and peripheral neuropathy, though the changes in arterial stiffness and hypertension were attenuated to non-significant levels.

This study convincingly shows that adolescents with DM2 are more likely to develop complications associated with diabetes, and the data hints that environmental factors may not be the sole cause of this difference. Based on this study, more focused investigations into the pathogenesis of DM1 and DM2 should begin to search for mechanistic differences that may explain the differences in complication rates between these two diseases.

Click to read the study, published today in JAMA

Relevant Reading: Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009

In-Depth [prospective cohort]: In 5 US cities, 2018 adolescents under the age of 20 were followed until age 21 in the SEARCH for Diabetes in Youth registry study. Those with DM2 were older at time of diagnosis, were more likely female, and more likely from minority groups than those with DM1. Other demographic data were similar. While those with DM2 had higher measures of obesity and mean arterial pressure, HbA1c counts were similar between groups. Those with DM2 were more likely to have diabetic kidney disease (absolute difference 14.0%; CI₉₅ 9.1%-19.9%), retinopathy (3.5%; CI₉₅ 0.4%-7.7%), peripheral neuropathy (9.2%; CI₉₅ 4.8- 14.4%), arterial stiffness (35.9%; CI₉₅ 29%-42.9%), and hypertension (11.5%; CI₉₅ 6.8%- 16.9%) without a change in cardiac autonomic neuropathy (p > 0.05). Adjustments for age or race did not attenuate the differences between groups. A final model accounting for hemoglobin A1c level, BMI, waist-height ratio, and mean arterial pressure averaged over time attenuated the findings for arterial stiffness and hypertension non-significant levels, though all other associations remained significantly elevated in DM2.

Image: PD

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