96-OR: Adverse Micro- and Macrovascular Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH and TODAY Studies

Abstract

We sought to determine incidence rates for micro- and macrovascular events in youth-onset type 1 (T1D) and type 2 (T2D) diabetes in the SEARCH (T1D: N=564; T2D: N=149) and TODAY (T2D: N=495) studies. At study visits, we ascertained self-reported ophthalmologic, kidney, neuropathy, cardiac, and peripheral and cerebrovascular events , obtained medical records for these events, and adjudicated each event using predetermined standardized and harmonized criteria. Data were available from more than 6,000 person-years in T1D and more than 8,000 person-years in T2D. Incidence rates (events per 10,000 person-years) were calculated. As shown in the table, despite similar mean diabetes duration of 10-13 years and mean HbA1c >9%, the incidence of reported complications was higher in the youth with T2D than those with T1D, with rates 2.5-fold higher for microvascular and 4.0-fold higher for macrovascular disease. These data support the aggressive nature of youth-onset T2D. Disclosure A.K.Mottl: Advisory Panel; Bayer AG, Board Member; Bayer AG, Research Support; Alexion Pharmaceuticals, Inc., Aurinia, Bayer AG, Boehringer Ingelheim International GmbH, Pfizer Inc. S.Isom: None. J.B.Tryggestad: None. R.Gubitosi-klug: None. L.M.Dolan: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck & Co., Inc. K.Drews: None. Funding National Institutes of Health DK061230; R01DK127208 Center for Disease Control

The 2022 American Diabetes Association Meeting

“…The authors concluded that continued use of these agents with eGFR < 30 is appropriate, although one could equally argue that unmeasured comorbidities both caused clinicians to discontinue the agents and increased likelihood of adverse outcome. On the other end of the spectrum, Mottl et al analyzed 564 and 644 persons with youth onset T1D and T2D at mean ages 21 and 26 with mean durations 11 and 13 years, respectively, in the Search for Diabetes in Youth (SEARCH) and Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) studies; respective prevalences of ophthalmologic events were 0.11% and 0.40%, of CKD none and 0.06%, of neuropathy 0.11% and 0.21%, and of macrovascular diagnoses 0.08% and 0.33% over 10–13 year of observation, with overall rates 2.5‐fold higher for microvascular and 4.0‐fold higher for macrovascular disease 13 . Horton and Snell‐Bergeon reported that in a cohort of 597 people with T1D, each 1 SD increment in HbA1c variability was associated with a 1.6‐fold increase in cardiovascular disease (CVD) events, and a similar increment in mean HbA1c was associated with a 1.4‐fold such increase 14 …”