Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes: an observational cohort study

Autor: Katherine A Sauder, Jeanette M Stafford, Elizabeth J Mayer-Davis, Elizabeth T Jensen, Sharon Saydah, Amy Mottl, Lawrence M Dolan, Richard F Hamman, Jean M Lawrence, Catherine Pihoker, Santica Marcovina, Ralph B D'Agostino, Dana Dabelea, Maryam Afkarian, James Amrhein, Natalie Beauregard, Ronny Bell, Anna Bellatorre, Clifford A. Bloch, Deborah Bowlby, Ralph D'Agostino, Stephen Daniels, Jasmin Divers, Lawrence M. Dolan, Vinod P. Gaur, Maureen T. Goldstein, Carla Greenbaum, Richard F. Hamman, Jessica Harting, Leora Henkin, Irl Hirsch, Kim Holmquist, Giuseppina Imperatore, Scott Isom, Malaka Jackson, Michael G. Kahn, Sue Kearns, Grace Kim, Georgeanna J. Klingensmith, Mary Klingsheim, Lisa Knight, Corinna Koebnick, Jean M. Lawrence, Xia Li, Angela D. Liese, Barbara Linder, Lenna L. Liu, Beth Loots, Kathy Love-Osborne, David Maahs, Santica M. Marcovina, Elizabeth J. Mayer-Davis, Anwar Merchant, Lina Merjaneh, Timothy Morgan, Debika Nandi-Munshi, John Neff, Bryce Nelson, Michael Pascual, David J. Pettitt, June Pierce, Jeffrey Powell, Beth Reboussin, Marian J. Rewers, Kristi Reynolds, Sharon H. Saydah, Jeanette Stafford, Debra A. Standiford, Greg Strylewicz, Craig Taplin, Lisa Testaverde, Joan Thomas, Paul Wadwa, Lynne E. Wagenknecht, Greta Wilkening, Carrie Williams, Davene Wright, Joyce Yi-Frazier
Rok vydání: 2019
Předmět:
Zdroj: The Lancet Child & Adolescent Health. 3:35-43
ISSN: 2352-4642
DOI: 10.1016/s2352-4642(18)30309-2
Popis: Summary Background One in three adolescents and young adults with type 1 diabetes have at least one early diabetes-related complication or comorbidity. We aimed to examine the prevalence and pattern of co-occurring complications in this population, as well as the related risk factors. Methods This observational cohort study includes data from individuals diagnosed with type 1 diabetes before age 20 years who participated in the SEARCH for Diabetes in Youth Study across five sites in the USA. We assessed sociodemographic and metabolic risk factors at baseline and at follow-up, and diabetes complications at follow-up. A frequency analysis was done to examine the difference in observed versus expected prevalence (calculated using a contingency table assuming independence across cells) of co-occurring complications or comorbidities. A cluster analysis was done to identify unique clusters of participants based on demographic characteristics and metabolic risk factors. Findings 1327 participants who completed the follow-up visit were included in the frequency analysis. The mean age was 10·1 (SD 3·9) years at the time of type 1 diabetes diagnosis and 18·0 (4·1) years at follow-up. At a mean diabetes duration of 7·8 [SD 1·9] years, co-occurrence of any two or more complications was observed in 78 (5·9%) participants, more frequently than expected by chance alone (58 [4·4%], p=0·015). Specifically, the complications that co-occurred more frequently than expected were retinopathy and diabetic kidney disease (11 [0·8%] vs three [0·2%]; p=0·0007), retinopathy and arterial stiffness (13 [1·0%] vs four [0·3%]; p=0·0016), and arterial stiffness and cardiovascular autonomic neuropathy (24 [1·8%] vs 13 [1·0%]; p=0·015). We identified four unique clusters characterised by progressively worsening metabolic risk factor profiles (longer duration of diabetes and higher glycated haemoglobin, non-HDL cholesterol, and waist-to-height ratio). The prevalence of at least two complications increased across the clusters (six [2·3%] of 261 in the low-risk cluster, 32 [6·3%] of 509 in the moderate-risk cluster, 28 [8%] of 348 in the high-risk cluster, and five [20·8%] of 24 in the highest-risk cluster). Compared with the low-risk and moderate-risk clusters, the high-risk and highest-risk clusters were characterised by a lower proportion of participants who were non-Hispanic white, and a higher proportion of participants who had a household income below US$50 000 and did not have private health insurance. Interpretation Early complications co-occur in adolescents and young adults with type 1 diabetes more frequently than expected. Identification of individuals with adverse risk factors could enable targeted behavioural or medical interventions that reduce the likelihood of early development of lifelong diabetes-related morbidity. Funding US Centers for Disease Control and Prevention, US National Institutes of Health.
Databáze: OpenAIRE
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