Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood
Open accessAbstract
Importance: The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown. Objective: To determine the prevalence of and risk factors for complications related to type 1 diabetes vs type 2 diabetes among teenagers and young adults who had been diagnosed with diabetes during childhood and adolescence. Design, Setting, and Participants: Observational study from 2002 to 2015 in 5 US locations, including 2018 participants with type 1 and type 2 diabetes diagnosed at younger than 20 years, with single outcome measures between 2011 and 2015. Exposures: Type 1 and type 2 diabetes and established risk factors (hemoglobin A1c level, body mass index, waist-height ratio, and mean arterial blood pressure). Main Outcomes and Measures: Diabetic kidney disease, retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, arterial stiffness, and hypertension. Results: Of 2018 participants, 1746 had type 1 diabetes (mean age, 17.9 years [SD, 4.1]; 1327 non-Hispanic white [76.0%]; 867 female patients [49.7%]), and 272 had type 2 (mean age, 22.1 years [SD, 3.5]; 72 non-Hispanic white [26.5%]; 181 female patients [66.5%]). Mean diabetes duration was 7.9 years (both groups). Patients with type 2 diabetes vs those with type 1 had higher age-adjusted prevalence of diabetic kidney disease (19.9% vs 5.8%; absolute difference [AD], 14.0%; 95% CI, 9.1%-19.9%; P < .001), retinopathy (9.1% vs 5.6%; AD, 3.5%; 95% CI, 0.4%-7.7%; P = .02), peripheral neuropathy (17.7% vs 8.5%; AD, 9.2%; 95% CI, 4.8%-14.4%; P < .001), arterial stiffness (47.4% vs 11.6%; AD, 35.9%; 95% CI, 29%-42.9%; P < .001), and hypertension (21.6% vs 10.1%; AD, 11.5%; 95% CI, 6.8%-16.9%; P < .001), but not cardiovascular autonomic neuropathy (15.7% vs 14.4%; AD, 1.2%; 95% CI, -3.1% to 6.5; P = .62). After adjustment for established risk factors measured over time, participants with type 2 diabetes vs those with type 1 had significantly higher odds of diabetic kidney disease (odds ratio [OR], 2.58; 95% CI, 1.39-4.81; P=.003), retinopathy (OR, 2.24; 95% CI, 1.11-4.50; P = .02), and peripheral neuropathy (OR, 2.52; 95% CI, 1.43-4.43; P = .001), but no significant difference in the odds of arterial stiffness (OR, 1.07; 95% CI, 0.63-1.84; P = .80) and hypertension (OR, 0.85; 95% CI, 0.50-1.45; P = .55). Conclusions and Relevance: Among teenagers and young adults who had been diagnosed with diabetes during childhood or adolescence, the prevalence of complications and comorbidities was higher among those with type 2 diabetes compared with type 1, but frequent in both groups. These findings support early monitoring of youth with diabetes for development of complications.
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Statin benefit for CVD is not evident in dialysis-dependent persons.
“However, the beneficial effect of statins is not apparent in persons who require dialysis.333,357,411–413”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [413]
The Diabetic Kidney Disease section defines kidney disease using albuminuria or reduced estimated glomerular filtration rate, while the Results compare complications in young people with type 1 and type 2 diabetes. Searches for statins, dialysis, and cardiovascular benefit found no passage addressing whether statins benefit people who require dialysis. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDiabetes during pregnancy predisposes offspring for the development of obesity, type 2 diabetes and cardiometabolic disease risk factors.
“Diabetes during pregnancy also predisposes offspring for the development of obesity, T2D and cardiometabolic disease risk factors [33,70,71,72,73,74,75,76,77] (Figure 1).”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [77]
The Abstract and Discussion compare complications and cardiovascular risk factors in young people with type 1 versus type 2 diabetes. Searches for maternal diabetes, pregnancy, and in-utero exposure found no passage addressing whether diabetes during pregnancy predisposes offspring to obesity, type 2 diabetes, or cardiometabolic risk factors. (LLM, conf=0.76)
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- Authors
- Dabelea, D., Stafford, J. M., Mayer-Davis, E. J., D’Agostino, R., Dolan, L., Imperatore, G., Linder, B., Lawrence, J. M., Marcovina, S. M., Mottl, A. K., Black, M. H., Pop-Busui, R., Saydah, S., Hamman, R. F., Pihoker, C., & for the SEARCH for Diabetes in Youth Research Group
- Affiliations
- Colorado School of Public Health (US)
- Wake Forest University Health Sciences (US)
- University of North Carolina at Chapel Hill (US)
- Cincinnati Children's Hospital Medical Center (US)
- Centers for Disease Control and Prevention (US)
- National Institutes of Health (US)
- Kaiser Permanente (US)
- University of Washington (US)
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor
- Corresponding author
- Dabelea, Dana
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2017-02-28
- Volume
- 317
- Issue
- 8
- Pages
- 825
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5483855
- OpenAlex
- W2593912695
- Cited by
- 700
- References
- 44
- Citations by year
- 2026: 48 · 2025: 81 · 2024: 79 · 2023: 89 · 2022: 97 · 2021: 74 · 2020: 77 · 2019: 62 · 2018: 65 · 2017: 27 · 2016: 1
- FWCI
- 49.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Medical University of South Carolina
- Cincinnati Children's Hospital Medical Center
- University of Washington
- University of South Carolina
- Seattle Children's Research Institute
- Greenville Health System
- National Institutes of Health (UL1TR000154, UL1TR000423, UL1TR001425, UL1TR001450, UL1TR002319)
- Centers for Disease Control and Prevention
- University of North Carolina at Chapel Hill
- Wake Forest School of Medicine
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK057516, K23DK093804, UC4DK108173, P30DK056350)
- National Center for Chronic Disease Prevention and Health Promotion (U01 DP-000247, U18 DP-002709, U18 DP006134, U18-DP-002708, U01-DP000246, U01-DP-000250, U01-DP-000254, U18 DP002714, U18 DP006139, U01 DP000248, U18 DP006138, U18 DP006136, U18 DP006131, U18 DP006133, U01DP000244, U18 DP002710)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, type 2 diabetes, youth-onset diabetes, diabetes complications, diabetic nephropathy, diabetic retinopathy, peripheral neuropathy, cardiac autonomic neuropathy, arterial stiffness, hypertension, comorbidities, young adults, glycemic control, HbA1c, body mass index, waist-to-height ratio, blood pressure, risk factors, complication prevalence
- MeSH terms
- Adolescent, Blood Pressure, Child, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypertension, Male, Risk Factors, Body Mass Index, Prevalence, Age of Onset, Diabetes Complications, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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