medwireNews: Patients with type 1 diabetes may develop multiple complications even before they reach adulthood, shows an analysis of the SEARCH for Diabetes in Youth Study.
The researchers found that 5.9% of 1327 study participants had two or more complications – diabetic kidney disease, diabetic retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, or arterial stiffness.
This was significantly higher than the rate of 4.4% that would be expected by chance alone, report Katherine Sauder (University of Colorado School of Medicine, Aurora, USA) and study co-authors in The Lancet Child & Adolescent Health.
The patients were aged an average of 10.1 years at diagnosis and 18.0 years at the time of the analysis, at which latter point their average glycated hemoglobin (HbA1c) level was 9.2% (76.8 mmol/mol).
The specific combinations of complications that occurred more frequently than expected were retinopathy plus diabetic kidney disease (0.8% vs 0.2% expected), retinopathy plus arterial stiffness (1.0 vs 0.3%), and arterial stiffness plus cardiovascular autonomic neuropathy (1.8 vs 1.0%).
“The imperative for screening is underwritten by the need and ability for intervention,” writes Fergus Cameron (Royal Children's Hospital, Parkville, Victoria, Australia) in a linked commentary, although he adds that there is uncertainty surrounding the best disease indicators and which interventions will be effective in adolescence.
But he notes that screening in youth has traditionally focused on renal and retinal complications, as well as co-occurring autoimmune diseases, whereas the current findings “indicate that autonomic and peripheral neuropathy and arterial wall stiffness might be more prevalent in young people with type 1 diabetes than previously assumed, and should be considered together.”
Cameron says: “Thus, these results might challenge current guidelines for complication screening programmes to consider additional and novel testing protocols.”
When the researchers categorized the patients into four groups based on their metabolic risk factors, there was a clear correlation between metabolic risk and the presence of complications.
For example, 78.9% of the 261 patients in the lowest-risk group had no diabetes complications and 2.3% had two or more, whereas only 41.7% of the 24 highest-risk patients were free of complications and 20.8% had two or more. However, despite the high prevalence of multiple complications in the high-risk group, the vast majority of patients with more than one complication fell into the two middle risk groups – 60 patients, compared with five and six in the highest- and lowest-risk groups, respectively.
Compared with lower-risk patients, those in the highest-risk group were more likely to be from a minority ethnic group and were less likely to have private healthcare insurance and to be in the top two categories (of four) for household income. Their average HbA1c was 11.8% (105 mmol/mol), compared with 8.5–9.7% (70–83 mmol/mol) in the other three metabolic risk groups.
In his commentary, however, Cameron cautions that these US study participants appeared to have a worse metabolic trajectory than adolescents from other geographic regions. “Thus, this US cohort might not be representative of type 1 diabetes outcomes in youth in other high-income countries,” he says.
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