Long-Term Complications and Mortality in Young-Onset Diabetes: Type 2 diabetes is more hazardous and lethal than type 1 diabetes

• Published in: Diabetes care Vol. 36; no. 12; pp. 3863 - 3869
• Main Authors: CONSTANTINO, Maria I, MOLYNEAUX, Lynda, LIMACHER-GISLER, Franziska, AL-SAEED, Abdulghani, LUO, Connie, WU, Ted, TWIGG, Stephen M, YUE, Dennis K, WONG, Jencia
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.12.2013
• Subjects: Adolescent; Adult; Australia; Biological and medical sciences; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cholesterol; Clinical outcomes; Complications and side effects; Diabetes; Diabetes Complications - mortality; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Forecasting; General aspects; Humans; Incidence; Male; Medical sciences; Metabolic diseases; Middle Aged; Mortality; New South Wales - epidemiology; Original Research; Patient outcomes; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Side effects; Survival analysis; Survival Rate - trends; Type 1 diabetes; Type 2 diabetes; Young Adult; Young adults; New South Wales; Australia; Endocrinopathy; Type 2 diabetes; Human; Immunopathology; Maturity onset diabetes young; Nutrition; Mortality; Autoimmune disease; Metabolic diseases; Epidemiology; Long term; Genetic disease; Type 1 diabetes; Complication; Endocrinology
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc12-2455

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. 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. 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). 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.