Youth with type 2 diabetes develop complications more often than type 1 peers
Health complications emerge earlier and are more aggressive in youths diagnosed with type 2 diabetes than peers with type 1 diabetes.
(Chapel Hill, N.C. – March 1, 2017) – Teens and young adults with type 2 diabetes develop kidney, nerve and eye disease, as well as some risk factors for heart disease, earlier than their peers with type 1 diabetes within eight years of diagnoses. The results, co-authored by a researcher at the University of North Carolina at Chapel Hill, are the latest findings of the SEARCH for Diabetes in Youth Study, which has been monitoring the burden of diabetes in youth under the age of 20 nationwide since 2000.
The work, reported in the Feb. 28 issue of the Journal of the American Medical Association, or JAMA, is the largest, most comprehensive longitudinal study to date to compare type 1 and type 2 diabetes diagnosed early in life and provide a followup perspective on how early medical complications emerge in the two conditions.
“This is the only study that exists in the country that is set up to compare type 1 and type 2 diabetes when conditions are diagnosed early in life,” said Elizabeth Mayer-Davis, the SEARCH study’s co-chair, co-author of the study and chair of the department of nutrition at UNC’s Gillings School of Global Public Health.
The study is significant because this is the first time that the health burdens of the two conditions could be compared at the same time, providing an unprecedented look at the emergence of health complication of the two diseases.
The researchers studied 1,746 adolescents and young adults with type 1 diabetes and 272 with type 2 diabetes and looked at five health complications of diabetes: retinopathy (eye disease), diabetic kidney disease, peripheral neuropathy (altered sensation in the feet), arterial stiffness and high blood pressure.
Overall, they found that health complications emerge faster in type 2 diabetes than type 1 diabetes, especially in minority youth with the disease. Specifically, one-third of teenagers and young adults with type 1 diabetes and almost 75 percent of those with type 2 diabetes had at least one health complication after eight years following a diagnosis. The effect was seen in diabetic kidney disease, retinopathy and peripheral neuropathy, but not in arterial stiffness or hypertension.
Other key findings include:
- For youth with type 2 diabetes, nearly 20 percent developed a sign of kidney disease by the end of the study, compared to about 6 percent of youth with type 1 diabetes.
- For youth with type 2, about 18 percent developed nerve disease, versus about 9 percent with type 1.
- For youth with type 2, about 9 percent developed eye disease, compared to about 6 percent of youth with type 1.
- Measures for two risk factors for heart disease (hypertension and arterial stiffness) were greater for youth with type 2 but close to equal for a third risk factor (cardiovascular autonomic neuropathy).
“In terms of chronic complications, type 2 seems to be more aggressive,” said Mayer-Davis. “These results would not necessarily be expected because acute complications like extremely high or low blood sugar that can lead to emergency room visits or hospitalization are more common in type 1 diabetes.”
Mayer-Davis explained it is critical to learn more about the best ways to reduce risk for longterm complications, in both type 1 and type 2 diabetes. “Both conditions emerge from a combination of genes and environment, but different genes and different environments,” she said. “We need to figure out how to reduce risk for complications in order to improve long term health for these young individuals.”
Five U.S. clinical centers and principal investigators participated. Along with Mayer-Davis, the SEARCH co-chair at UNC’s Gillings School who also collaborated with the University of South Carolina’s School of Public Health, the researchers and centers included: the study’s first author and study co-chair Dana Dabelea at Colorado School of Public Health, Catherine Pihoker at Seattle Children’s Hospital, Jean Lawrence at Kaiser Permanente Southern California and Larry Dolan at Cincinnati Children’s Hospital. The study’s central laboratory is at the Northwest Lipid Research Laboratory and overseen by Santica Marcovina. Its coordinating center is at the Wake Forest School of Medicine, co-directed by Ralph D’Agostino and Lynne Wagenknecht.
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