Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes

an observational cohort study

SEARCH for Diabetes in Youth Study Group

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)35-43
Number of pages9
JournalThe Lancet Child and Adolescent Health
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2019

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Diabetes Complications
Type 1 Diabetes Mellitus
Observational Studies
Young Adult
Cohort Studies
Vascular Stiffness
Comorbidity
National Institutes of Health (U.S.)
Glycosylated Hemoglobin A
Diabetic Nephropathies
Health Insurance
Centers for Disease Control and Prevention (U.S.)
Cluster Analysis
Cholesterol
Demography
Morbidity
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology

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Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes : an observational cohort study. / SEARCH for Diabetes in Youth Study Group.

In: The Lancet Child and Adolescent Health, Vol. 3, No. 1, 01.01.2019, p. 35-43.

Research output: Contribution to journalArticle

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title = "Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes: an observational cohort study",
abstract = "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.",
author = "{SEARCH for Diabetes in Youth Study Group} and Sauder, {Katherine A.} and Dana Dabelea and Stafford, {Jeanette M.} and D'Agostino, {Ralph B.} and Jensen, {Elizabeth T.} and Mayer-Davis, {Elizabeth J.} and Sharon Saydah and Amy Mottl and Dolan, {Lawrence M.} and Hamman, {Richard F.} and Dana Dabelea and Lawrence, {Jean M.} and Catherine Pihoker and Santica Marcovina and Maryam Afkarian and James Amrhein and Natalie Beauregard and Ronny Bell and Anna Bellatorre and Bloch, {Clifford A.} and Deborah Bowlby and Ralph D'Agostino and Dana Dabelea and Stephen Daniels and Jasmin Divers and Dolan, {Lawrence M.} and Gaur, {Vinod P.} and Goldstein, {Maureen T.} and Carla Greenbaum and Hamman, {Richard F.} and Jessica Harting and Leora Henkin and Irl Hirsch and Kim Holmquist and Giuseppina Imperatore and Scott Isom and Malaka Jackson and Kahn, {Michael G.} and Sue Kearns and Grace Kim and Klingensmith, {Georgeanna J.} and Mary Klingsheim and Lisa Knight and Corinna Koebnick and Lawrence, {Jean M.} and Xia Li and Liese, {Angela D.} and Barbara Linder and Liu, {Lenna L.} and Beth Loots",
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T1 - Co-occurrence of early diabetes-related complications in adolescents and young adults with type 1 diabetes

T2 - an observational cohort study

AU - SEARCH for Diabetes in Youth Study Group

AU - Sauder, Katherine A.

AU - Dabelea, Dana

AU - Stafford, Jeanette M.

AU - D'Agostino, Ralph B.

AU - Jensen, Elizabeth T.

AU - Mayer-Davis, Elizabeth J.

AU - Saydah, Sharon

AU - Mottl, Amy

AU - Dolan, Lawrence M.

AU - Hamman, Richard F.

AU - Dabelea, Dana

AU - Lawrence, Jean M.

AU - Pihoker, Catherine

AU - Marcovina, Santica

AU - Afkarian, Maryam

AU - Amrhein, James

AU - Beauregard, Natalie

AU - Bell, Ronny

AU - Bellatorre, Anna

AU - Bloch, Clifford A.

AU - Bowlby, Deborah

AU - D'Agostino, Ralph

AU - Dabelea, Dana

AU - Daniels, Stephen

AU - Divers, Jasmin

AU - Dolan, Lawrence M.

AU - Gaur, Vinod P.

AU - Goldstein, Maureen T.

AU - Greenbaum, Carla

AU - Hamman, Richard F.

AU - Harting, Jessica

AU - Henkin, Leora

AU - Hirsch, Irl

AU - Holmquist, Kim

AU - Imperatore, Giuseppina

AU - Isom, Scott

AU - Jackson, Malaka

AU - Kahn, Michael G.

AU - Kearns, Sue

AU - Kim, Grace

AU - Klingensmith, Georgeanna J.

AU - Klingsheim, Mary

AU - Knight, Lisa

AU - Koebnick, Corinna

AU - Lawrence, Jean M.

AU - Li, Xia

AU - Liese, Angela D.

AU - Linder, Barbara

AU - Liu, Lenna L.

AU - Loots, Beth

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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JO - The Lancet Child and Adolescent Health

JF - The Lancet Child and Adolescent Health

SN - 2352-4642

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