COMMENTARY

Entering Adulthood With Diabetes

Even Parental Divorce Affects Diabetes Management

Gregory A. Nichols, PhD

Disclosures

July 13, 2017

Do Type 1 and Type 2 Diabetes Convey Similar Risk for Complications?

We may think of diabetes as a disease of the young (type 1) or of the middle-aged or older (type 2). In reality, of course, children with type 1 diabetes mellitus (T1DM) age into adulthood. Moreover, type 2 diabetes mellitus (T2DM) is becoming increasingly common among youth (who will also age into adulthood).[1]

Not only is T2DM more common, but it also may be more aggressive than T1DM, according to research by Amutha and colleagues.[2]

They identified 108 patients with T1DM and 90 patients with T2DM from electronic medical records who were diagnosed between 10 and 25 years of age and had no evidence of complications. These patients were followed up regularly over a median of 5 years with detailed examinations to assess retinopathy (using retinal photography), nephropathy (urinary albumin excretion ≥ 30 mg/g of creatinine), neuropathy (using biothesiometry), peripheral vascular disease (using ankle-brachial index), and ischemic heart disease (history of myocardial infarction or coronary revascularization, ECG changes with Q waves, or drug treatment [aspirin/clopidogrel with vasodilators and/or β-blockers]).[2]

Microvascular complications were over twice as likely to occur in patients with T2DM.

Patients with T1DM were about 4 years younger than those with T2DM (27 vs 31 years at follow-up); duration of diabetes was similar. Hypertension and hyperlipidemia were much more common among patients with T2DM than those with T1DM (28.9% vs 11.1% [P = .002] and 50.0% vs 21.3% [P < .001]), respectively.

Despite these differences and undoubtedly due to age, macrovascular complications in both groups were too rare to compare. However, microvascular complications were over twice as likely to occur in patients with T2DM after adjustment for age, A1c, total cholesterol, and systolic blood pressure.[2]

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