Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes: an observational cohort study

Abstract

Background. One in three adolescents and young adults with type 1 diabetes have at least one early diabetes-related complication/comorbidity. However, the prevalence, patterning, and risk factors for co-occurring complications in this population are not well understood. Methods. The SEARCH for Diabetes in Youth observational cohort study includes 1327 individuals diagnosed with type 1 diabetes before 20 years of age from 5 United States locations. Sociodemographic and metabolic risk factors were assessed at baseline (mean diabetes duration = 0·8 years, mean age = 10·9 years) and follow-up (mean diabetes duration = 7.8 years, mean age = 18·0 years). Early diabetes complications (diabetic kidney disease, diabetic retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, and arterial stiffness) were assessed at follow-up. We aimed to describe co-occurrence of complications and examine differences in co-occurrence within demographic and metabolic risk factor clusters identified using cluster analysis. Findings. Overall, co-occurrence of any ≥2 complications was observed in 5·9% of all participants, more frequently than expected by chance alone (4·4%, p=0·015). Specifically, retinopathy and diabetic kidney disease, retinopathy and arterial stiffness, and arterial stiffness and cardiac autonomic neuropathy all co-occurred more frequently than expected (all p<0·05). The cluster analysis produced four unique clusters characterized by progressively worsening metabolic risk factor profiles (longer duration; higher A1c, non-HDL cholesterol, and waist to height ratio) and differences in sociodemographic characteristics (race/ethnicity, household income, type of health insurance). Prevalence of ≥2 complications progressively increased with worsening metabolic profiles (from 2·3% to 20·8%, p<0·001). Interpretation. We report that early complications co-occur in adolescents and young adults with type 1 diabetes more frequently than expected after an average of less than eight years of diabetes duration. A cluster of high risk factors identifies groups that may benefit most from interventions to reduce complications.

A new strategy for vascular complications in young people with type 1 diabetes mellitus

“…Adolescence is a high risk period for the development of complications of T1DM, as optimal glycaemic control is difficult to achieve, due to the effect of hormonal changes and psychosocial factors 13,14 . The first signs of vascular complications appear during adolescence and subclinical manifestations are common, however, hard endpoints, such as overt proteinuria, proliferative retinopathy or cardiovascular events are rare 15,16 . Subclinical manifestations include early increases in urinary albumin excretion, changes in the retinal microvasculature and subclinical changes in large blood vessels, including increased arterial stiffness, aortic intima-media thickness (aIMT) and carotid intima-media thickness (cIMT) 15 (Figure 1).…”

Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real‐life conditions

“…Young people with diabetes have high mortality due to acute metabolic complications (diabetic ketoacidosis, dead‐in‐bed syndrome), but also due to cardiovascular diseases leading to reduced life expectancy . In particular, those with diabetes onset below the age of 10 years seem to be vulnerable with a life expectancy almost 14–18 years shorter than that of their peers from the general population . Furthermore, a young child's cognitive development can be impaired by hyperglycaemia and diabetic ketoacidosis .…”

Progression to hypertension in youth and young adults with type 1 or type 2 diabetes: The SEARCH for Diabetes in Youth Study

“…The SEARCH study has previously shown that the number of cardiovascular risk factors did not change significantly in participants with type 1 diabetes, but increased over time in participants with type 2 diabetes, a diabetic phenotype with a higher prevalence of obesity at diagnosis 34 . Early complications of diabetes co‐occurred in adolescents and young adults with diabetes, and included arterial stiffness and hypertension 35 . Youths and young adults with type 2 diabetes had a higher age‐adjusted prevalence of macrovascular outcomes such as arterial stiffness and hypertension than youths and young adults with type 1 diabetes 6 .…”