Cited by 423Diabetes Management and ResearchDiabetes and associated disordersDiabetes Treatment and Management

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Long-Term Complications and Mortality in Young-Onset Diabetes

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Constantino, Maria I., Molyneaux, Lynda, Limacher-Gisler, Franziska, Al-Saeed, Abdulghani, Luo, Connie, Wu, Ted, Twigg, Stephen M., Yue, Dennis K., Wong, Jencia·2013·Diabetes Care

DOI 10.2337/dc12-2455PMC PMC3836093

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Abstract

OBJECTIVE: To evaluate long-term clinical outcomes and survival in young-onset type 2 diabetes (T2DM) compared with type 1 diabetes (T1DM) with a similar age of onset. RESEARCH DESIGN AND METHODS: Records from the Royal Prince Alfred Hospital Diabetes Clinical Database, established in 1986, were matched with the Australian National Death Index to establish mortality outcomes for all subjects until June 2011. Clinical and mortality outcomes in 354 patients with T2DM, age of onset between 15 and 30 years (T2DM15–30), were compared with T1DM in several ways but primarily with 470 patients with T1DM with a similar age of onset (T1DM15–30) to minimize the confounding effect of age on outcome. RESULTS: For a median observation period of 21.4 (interquartile range 14–30.7) and 23.4 (15.7–32.4) years for the T2DM and T1DM cohorts, respectively, 71 of 824 patients (8.6%) died. A significant mortality excess was noted in T2DM15–30 (11 vs. 6.8%, P = 0.03), with an increased hazard for death (hazard ratio 2.0 [95% CI 1.2–3.2], P = 0.003). Death for T2DM15–30 occurred after a significantly shorter disease duration (26.9 [18.1–36.0] vs. 36.5 [24.4–45.4] years, P = 0.01) and at a relatively young age. There were more cardiovascular deaths in T2DM15–30 (50 vs. 30%, P < 0.05). Despite equivalent glycemic control and shorter disease duration, the prevalence of albuminuria and less favorable cardiovascular risk factors were greater in the T2DM15–30 cohort, even soon after diabetes onset. Neuropathy scores and macrovascular complications were also increased in T2DM15–30 (P < 0.0001). CONCLUSIONS: Young-onset T2DM is the more lethal phenotype of diabetes and is associated with a greater mortality, more diabetes complications, and unfavorable cardiovascular disease risk factors when compared with T1DM.

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Figure 1 A: Kaplan-Meier survival curve for T2DM15–30 (n = 357) and T1DM15–30 (n = 470) patients. B: Kaplan-Meier survival curve for T2DM15–30 and all T1DM (age of onset <30 years) (n = 870) patients.CC BY-NC-ND · PubMed Central

Figure 2 Kaplan-Meier curve for cardiovascular deaths.CC BY-NC-ND · PubMed Central

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Method
Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis
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Result
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Result
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Age, age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes
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Type 2 Diabetes in Children and Adolescents
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“A long-term cohort study from Australia, established in 1986, linked hospital records with the Australian national death index to establish mortality outcomes for 354 patients with T2D with 470 patients with T1D, all with ages of onset between 15 and 30 years.(20) Although this cohort contains both patients with youth…”
BackgroundResultInfluential
The characteristics of newly diagnosed adult early-onset diabetes: a population-based cross-sectional study
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“…and microvascular complications in type 2 diabetes compared with type 1 (Kershnar et al. 2006; Maahs et al. 2007; Rodriguez et al. 2010; Constantino et al. 2013), and greater effects of diabetes on hearing may be found among individuals younger than 50 years of age (Dalton et al. 1998;…”
Background
Suppressive Effects of Clerodendrum volubile P Beauv. [Labiatae] Methanolic Extract and Its Fractions on Type 2 Diabetes and Its Complications
Erukainure, O. L., Hafizur, R. M., Kabir, N., Choudhary, M. I., Atolanı, O., Banerjee, P., Preißner, R., Chukwuma, C. I., Muhammad, A. I., Amonsou, E. O., et al. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.00008 · Cited by 59
“Increased hyperglycemia triggers excessive production of free radicals, resulting in oxidative stress (Tiwari et al., 2013), which is responsible for the pathogenesis of most diabetic micro- and macro-vascular complications (Constantino et al., 2013).”
Background
Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines
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“A cohort of 354 patients with T2DM and 470 patients with T1DMwith similar age of onset between 15 and 30 years were compared to study the clinical and mortality outcomes in Australia (Constantino et al., 2013).”
Result
Evaluating health-related quality of life in type 1 diabetes: a systematic literature review of utilities for adults with type 1 diabetes
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Morbidity and Mortality in Young-Onset Type 2 Diabetes in Comparison to Type 1 Diabetes: Where Are We Now?
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Self-citation

Authors: Constantino, M. I., Molyneaux, L., Limacher-Gisler, F., Al-Saeed, A., Luo, C., Wu, T., Twigg, S. M., Yue, D. K., & Wong, J.
Affiliations: The University of Sydney (AU)
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia;
Royal Prince Alfred Hospital (AU)
Corresponding author: Constantino, Maria I.
ORCID: Constantino, Maria I.
Wu, Ted
Twigg, Stephen M.
Yue, Dennis K.
Wong, Jencia
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2013-11-13
Volume: 36
Issue: 12
Pages: 3863-3869
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc12-2455
PMC: PMC3836093
OpenAlex: W2112954588
Semantic Scholar: 305edc35a7998be9c33ffe827fe4d3a51d64470f
Cited by: 423
References: 23
Citations by year: 2026: 17 · 2025: 22 · 2024: 43 · 2023: 30 · 2022: 34 · 2021: 48 · 2020: 39 · 2019: 38 · 2018: 30 · 2017: 29 · 2016: 31 · 2015: 34 · 2014: 24 · 2013: 3
FWCI: 24.38
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
Locations: Diabetes Care (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Funders: American Diabetes Association
University of Sydney
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 Treatment and Management
Keywords: youth-onset type 2 diabetes, type 1 diabetes, mortality, cardiovascular mortality, albuminuria, diabetic nephropathy, diabetic neuropathy, macrovascular complications, disease duration, cardiovascular risk factors, late complications
MeSH terms: Adolescent, Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Forecasting, Humans, Male, Middle Aged, New South Wales, Retrospective Studies, Risk Factors, Incidence, Prevalence, Survival Rate, Diabetes Complications, Young Adult

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Long-Term Complications and Mortality in Young-Onset Diabetes

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