medwireNews: Findings from a US population-based study reveal a strikingly high rate of complications among teenagers and young adults who were diagnosed with type 2 diabetes during childhood or adolescence.

The study, which is published in JAMA, shows that the 272 patients with type 2 diabetes had a significantly higher likelihood of having diabetic kidney disease, retinopathy and peripheral neuropathy than the 1746 with type 1 diabetes.

“I think the take-home message is important and one that probably needs to have its profile raised within the paediatric diabetes community,” John Gregory, Professor of Paediatric Endocrinology at Cardiff University, UK, told medwireNews.

He observes that type 2 diabetes is rather a “Cinderella area” within paediatrics, not being “associated with all the excitement and the high-tech stuff like pumps and so on that dominate the agenda in type 1.”

Complications were frequent in both groups of patients, however. At an estimated age of 21 years, and having had diabetes for around 8 years, 32% of type 1 diabetes patients had at least one complication, as did 72% of those with type 2 diabetes, report Dana Dabelea (Colorado School of Public Health, Aurora, USA) and co-researchers.

After accounting for age, the most frequent complications in type 1 diabetes patients were cardiovascular autonomic neuropathy (14.4%), arterial stiffness (11.6%) and hypertension (10.1%). The most common in type 2 diabetes patients were arterial stiffness (47.4%), hypertension (21.6%) and diabetic kidney disease (19.9%).

All complications occurred at a higher rate in patients with type 2 than type 1 diabetes; this was limited to diabetic kidney disease, retinopathy and peripheral neuropathy, with risk increases of around 2.5-fold, after accounting for the influence of confounders including age, average glycated haemoglobin level over time, waist-to-height ratio and blood pressure.

The total 2018 patients were part of the SEARCH for Diabetes in Youth registry study – those of the originally identified 7929 patients diagnosed with diabetes during childhood or adolescence who attended the baseline and follow-up study visits.

Gregory notes that it is hard to be sure that the included patients were truly representative of the whole cohort. Although the study authors report that demographics were similar between patients who did and did not attend baseline screening, Gregory says that “by definition, three-quarters of people didn’t want to take part in this study, [so] are probably individuals who are less engaged.”

He also notes that the ethnic mix of the cohort is specific to the USA, with substantial proportions of the patients being Black or Hispanic. In particular, 42.6% of the type 2 diabetes patients were non-Hispanic Black – the largest proportion.

Nonetheless, Gregory believes that the findings are an important message for paediatricians in other countries. “I think [the data] raise the point that perhaps as paediatricians we don’t really think enough about the management of type 2.”

With the “overwhelming majority” of paediatric patients having type 1 diabetes, he says: “I do worry about the type 2s in our clinic. I think we have very little experience in treating them.” He stresses that clinicians are reliant on data from studies of adults with type 2 diabetes, because of its rarity among children. “It’s really very difficult – they’re almost like the lost tribe within the world of diabetes.”

Nonetheless, Gregory suggests that paediatric services could “take more from the world of adult diabetes, where they are much more familiar with type 2 diabetes and much more familiar with the potential interventions there are to optimally manage this group.”

By Eleanor McDermid

JAMA 2017; 317: 825–835

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