Skip to main content

Advertisement

Log in

Morbidity and Mortality in Young-Onset Type 2 Diabetes in Comparison to Type 1 Diabetes: Where Are We Now?

  • Pediatric Type 2 Diabetes (PS Zeitler, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Increasingly, we recognise that type 2 diabetes in youth is a disease with an aggressive time course and a significant complication risk. On the other hand, outcomes for youth with type 1 diabetes appear generally to be improving. With increasing numbers of both types of diabetes in youth, it is timely that a comparative perspective is offered to help clinicians prognosticate more appropriately. Contemporary comparative studies add a new perspective to a consistent story, that for youth-onset type 2 diabetes, the development and progression of cardio-renal complications are increased and the survival prognosis is significantly worse than for type 1 diabetes. Here, we review this mounting evidence, highlight the importance of metabolic syndrome factors in the excess risk and underscore that there remains a significant mortality gap for youth with either type of diabetes, to be addressed as a matter of urgency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M. Diabetes in the young—a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract. 2014;103(2):161–75.

    Article  PubMed  Google Scholar 

  2. Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes. 2012;19(2):93–6.

    Article  PubMed  Google Scholar 

  3. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29.

    Article  Google Scholar 

  4. Imperatore GMDP, Boyle JPPHD, Thompson TJMS, Case DPHD, Dabelea DMD, et al. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth. Diabetes Care. 2012;35(12):2515–20. This study provides estimates of the future burden of disease in the context of increaing numbers of youth with type 1 and type 2 diabetes.

  5. Dabelea D, Bell RA, D’Agostino Jr RB, Imperatore G, Johansen JM, Linder B, et al. Incidence of diabetes in youth in the United States. JAMA J Am Med Assoc. 2007;297(24):2716–24.

    Article  Google Scholar 

  6. Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA J Am Med Assoc. 2014;311(17):1778–86.

    Article  CAS  Google Scholar 

  7. Liese AD, D’Agostino Jr RB, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;118(4):1510–8.

    Article  PubMed  Google Scholar 

  8. TODAY Study Group, Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56. The TODAY trial is the first RCT examining diabetes management in YT2DM. Publications arising from this trial highlight the severe phenotype in YT2DM, the progressive beta cell decline and progression of risk factors for this patient group.

  9. TODAY Study Group, Copeland KC, Zeitler P, Geffner M, Guandalini C, Higgins J, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab. 2011;96(1):159–67.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care. 2013;36(6):1735–41.

    Article  PubMed Central  Google Scholar 

  11. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and beta-cell function in TODAY. Diabetes Care. 2013;36(6):1749–57.

    Article  PubMed Central  Google Scholar 

  12. TODAY Study Group. Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care. 2013;36(6):1758–64.

    Article  PubMed Central  Google Scholar 

  13. TODAY Study Group. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care. 2013;36(6):1772–4.

    Article  PubMed Central  Google Scholar 

  14. Yokoyama H, Okudaira M, Otani T, Takaike H, Miura J, Saeki A, et al. Existence of early-onset NIDDM Japanese demonstrating severe diabetic complications. Diabetes Care. 1997;20(5):844–7.

    Article  CAS  PubMed  Google Scholar 

  15. Luk AO, Lau ES, So WY, Ma RC, Kong AP, Ozaki R, et al. Prospective study on the incidences of cardiovascular-renal complications in Chinese patients with young-onset type 1 and type 2 diabetes. Diabetes Care. 2014;37(1):149–57. YT2DM is a growing problem in Asia and this large study is one of few that examines diabetes complications specifically in Chinese with obese and non obese YT2DM, in comparison to T1DM.

  16. Hillier TA, Pedula KL. Complications in young adults with early-onset type 2 diabetes: losing the relative protection of youth. Diabetes Care. 2003;26(11):2999–3005.

    Article  PubMed  Google Scholar 

  17. Wong J, Molyneaux L, Constantino M, Twigg SM, Yue DK. Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors. Diabetes Care. 2008;31(10):1985–90.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Pambianco G, Costacou T, Ellis D, Becker DJ, Klein R, Orchard TJ. The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes. 2006;55(5):1463–9.

    Article  CAS  PubMed  Google Scholar 

  19. Miller RG, Secrest AM, Ellis D, Becker DJ, Orchard TJ. Changing impact of modifiable risk factors on the incidence of major outcomes of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care. 2013;36(12):3999–4006.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Scott CR, Smith JM, Cradock MM, Pihoker C. Characteristics of youth-onset noninsulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus at diagnosis. Pediatrics. 1997;100(1):84–91.

    Article  CAS  PubMed  Google Scholar 

  21. Eppens MC, Craig ME, Cusumano J, Hing S, Chan AKF, Howard NJ, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care. 2006;29(6):1300–6.

    Article  PubMed  Google Scholar 

  22. Yokoyama H, Okudaira M, Otani T, Sato A, Miura J, Takaike H, et al. Higher incidence of diabetic nephropathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int. 2000;58(1):302–11.

    Article  CAS  PubMed  Google Scholar 

  23. Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet. 2007;369(9575):1823–31.

    Article  PubMed  Google Scholar 

  24. Dart AB, Sellers EA, Martens PJ, Rigatto C, Brownell MD, Dean HJ. High burden of kidney disease in youth-onset type 2 diabetes. Diabetes Care. 2012;35(6):1265–71. This large study examines the burden of kidney disease and end-stage renal disease using prospectively collected data in YT2DM and type 1 diabetes.

  25. Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G, et al. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care. 2007;30(10):2593–8.

    Article  PubMed  Google Scholar 

  26. McGrath NM, Parker GN, Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori. Diabetes Res Clin Pract. 1999;43(3):205–9.

    Article  CAS  PubMed  Google Scholar 

  27. Adelman RD, Restaino IG, Alon US, Blowey DL. Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents. J Pediatr. 2001;138(4):481–5.

    Article  CAS  PubMed  Google Scholar 

  28. Constantino MI, Molyneaux L, Limacher-Gisler F, Al-Saeed A, Luo C, Wu T, et al. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care. 2013;36(12):3863–9. This study utilises a long-term diabetes database to examine the long-term mortality differences in type 1 and type 2 diabetes of equivalent age of onset.

  29. Salardi S, Porta M, Maltoni G, Rubbi F, Rovere S, Cerutti F, et al. Infant and toddler type 1 diabetes: complications after 20 years’ duration. Diabetes Care. 2012;35(4):829–33.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Donaghue KC, Fairchild JM, Craig ME, Chan AK, Hing S, Cutler LR, et al. Do all prepubertal years of diabetes duration contribute equally to diabetes complications? Diabetes Care. 2003;26(4):1224–9.

    Article  PubMed  Google Scholar 

  31. Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care. 2014;37(3):867–75.

    Article  PubMed  Google Scholar 

  32. Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281:64–91.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Sellers EA, Blydt-Hansen TD, Dean HJ, Gibson IW, Birk PE, Ogborn M. Macroalbuminuria and renal pathology in First Nation youth with type 2 diabetes. Diabetes Care. 2009;32(5):786–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Wong J. Is there benefit in dual renin-angiotensin-aldosterone system blockade? No, yes and maybe: a guide for the perplexed. Diabetes Vasc Dis Res Off J Int Soc Diabetes Vasc Dis. 2013;10(3):193–201.

    Article  Google Scholar 

  35. Dart AB, Martens PJ, Rigatto C, Brownell MD, Dean HJ, Sellers EA. Earlier onset of complications in youth with type 2 diabetes. Diabetes Care. 2014;37(2):436–43.

    Article  CAS  PubMed  Google Scholar 

  36. Mayer-Davis EJ, Davis C, Saadine J, D’Agostino Jr RB, Dabelea D, Dolan L, et al. Diabetic retinopathy in the SEARCH for Diabetes in Youth Cohort: a pilot study. Diabet Med. 2012;29(9):1148–52.

    Article  CAS  PubMed  Google Scholar 

  37. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care. 1992;15(7):815–9.

    Article  CAS  PubMed  Google Scholar 

  38. Jaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care. 2013;36(12):3903–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352(4):341–50.

    Article  CAS  PubMed  Google Scholar 

  40. Duca L, Sippl R, Snell-Bergeon JK. Is the risk and nature of CVD the same in type 1 and type 2 diabetes? Curr Diabetes Rep. 2013;13(3):350–61.

    Article  CAS  Google Scholar 

  41. Rodriguez BL, Fujimoto WY, Mayer-Davis EJ, Imperatore G, Williams DE, Bell RA, et al. Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2006;29(8):1891–6.

    Article  PubMed  Google Scholar 

  42. West NA, Hamman RF, Mayer-Davis EJ, D’Agostino Jr RB, Marcovina SM, Liese AD, et al. Cardiovascular risk factors among youth with and without type 2 diabetes: differences and possible mechanisms. Diabetes Care. 2009;32(1):175–80.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Gordon SM, Davidson WS, Urbina EM, Dolan LM, Heink A, Zang H, et al. The effects of type 2 diabetes on lipoprotein composition and arterial stiffness in male youth. Diabetes. 2013;62(8):2958–67.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Whalley GA, Gusso S, Hofman P, Cutfield W, Poppe KK, Doughty RN, et al. Structural and functional cardiac abnormalities in adolescent girls with poorly controlled type 2 diabetes. Diabetes Care. 2009;32(5):883–8.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Alman AC, Talton JW, Wadwa RP, Urbina EM, Dolan LM, Daniels SR, et al. Cardiovascular health in adolescents with type 1 diabetes: The SEARCH CVD Study. Pediatr Diabetes. 2014;15(7):502–10. doi:10.1111/pedi.12120.

  46. Wadwa RP, Urbina EM, Anderson AM, Hamman RF, Dolan LM, Rodriguez BL, et al. Measures of arterial stiffness in youth with type 1 and type 2 diabetes the SEARCH for diabetes in youth study. Diabetes Care. 2010;33(4):881–6.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Orchard TJMD. The changing face of young-onset diabetes: type 1 optimism mellowed by type 2 concerns. Diabetes Care. 2013;36(12):3857–9.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Prevention CfDca. FastStats—deaths and mortality.

  49. Vergouwe Y, Soedamah-Muthu SS, Zgibor J, Chaturvedi N, Forsblom C, Snell-Bergeon JK, et al. Progression to microalbuminuria in type 1 diabetes: development and validation of a prediction rule. Diabetologia. 2010;53(2):254–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry. Diabetes Care. 2010;33(12):2573–9.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes. 2012;61(11):2987–92. The Pittsburgh EDC study is an important population study which provides new evidence for improving outcomes in T1DM.

  52. Jorgensen ME, Almdal TP, Carstensen B. Time trends in mortality rates in type 1 diabetes from 2002 to 2011. Diabetologia. 2013;56(11):2401–4.

    Article  PubMed  Google Scholar 

  53. Harjutsalo V, Forsblom C, Groop PH. Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ Br Med J. 2011;343:d5364.

    Article  Google Scholar 

  54. Morimoto A, Onda Y, Nishimura R, Sano H, Utsunomiya K, Tajima N. Cause-specific mortality trends in a nationwide population-based cohort of childhood-onset type 1 diabetes in Japan during 35 years of follow-up: the DERI Mortality Study. Diabetologia. 2013;56(10):2171–5.

    Article  CAS  PubMed  Google Scholar 

  55. Harding JL, Shaw JE, Peeters A, Guiver T, Davidson S, Magliano DJ. Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997-2010. Diabetes Care. 2014;37(9):2579–86.

    Article  PubMed  Google Scholar 

  56. Washington RE, Orchard TJ, Arena VC, Laporte RE, Tull ES. Incidence of type 1 and type 2 diabetes in youth in the U.S. Virgin Islands, 2001–2010. Pediatr Diabetes. 2013;14(4):280–7.

    Article  PubMed  Google Scholar 

  57. O’Grady MJ, Delaney J, Jones TW, Davis EA. Standardised mortality is increased three-fold in a population-based sample of children and adolescents with type 1 diabetes. Pediatr Diabetes. 2013;14(1):13–7.

    Article  PubMed  Google Scholar 

  58. Orchard TJ, Secrest AM, Miller RG, Costacou T. In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologia. 2010;53(11):2312–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Groop PH, Thomas MC, Moran JL, Waden J, Thorn LM, Makinen VP, et al. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009;58(7):1651–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Allemann S, Saner C, Zwahlen M, Christ ER, Diem P, Stettler C. Long-term cardiovascular and non-cardiovascular mortality in women and men with type 1 and type 2 diabetes mellitus: a 30-year follow-up in Switzerland. Swiss Med Wkly. 2009;139(39–40):576–83.

    PubMed  Google Scholar 

  61. Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA J Am Med Assoc. 2006;296(4):421–6.

    Article  CAS  Google Scholar 

  62. Rhodes E, Prosser L, Hoerger T, Lieu T, Ludwig D, Laffel L. Estimated morbidity and mortality in adolescents and young adults diagnosed with type 2 diabetes mellitus. Diabet Med. 2012;29(4):453–63.

    Article  CAS  PubMed  Google Scholar 

  63. Waernbaum I, Blohmé G, Östman J, Sundkvist G, Eriksson J, Arnqvist H, et al. Excess mortality in incident cases of diabetes mellitus aged 15 to 34 years at diagnosis: a population-based study (DISS) in Sweden. Diabetologia. 2006;49(4):653–9.

    Article  CAS  PubMed  Google Scholar 

  64. Conway BN, May ME, Signorello LB, Blot WJ. Mortality experience of a low-income population with young-onset diabetes. Diabetes Care. 2012;35(3):542–8.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Dyck RF, Jiang Y, Osgood ND. The long-term risks of end stage renal disease and mortality among First Nations and non-First Nations people with youth-onset diabetes. Can J Diabetes. 2014;38(4):237–43. doi:10.1016/j.jcjd.2014.03.005.

  66. Merger SR, Leslie RD, Boehm BO. The broad clinical phenotype of type 1 diabetes at presentation. Diabet Med. 2013;30(2):170–8.

    Article  CAS  PubMed  Google Scholar 

  67. Cleland SJ, Fisher BM, Colhoun HM, Sattar N, Petrie JR. Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks? Diabetologia. 2013;56(7):1462–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Mottl AK, Lauer A, Dabelea D, Maahs DM, D’Agostino Jr RB, Dolan LM, et al. Albuminuria according to status of autoimmunity and insulin sensitivity among youth with type 1 and type 2 diabetes. Diabetes Care. 2013;36(11):3633–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Linder BL, Fradkin JE, Rodgers GP. The TODAY study: an NIH perspective on its implications for research. Diabetes Care. 2013;36(6):1775–6.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Jencia Wong, Maria Constantino and Dennis Yue declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jencia Wong.

Additional information

This article is part of the Topical Collection on Pediatric Type 2 Diabetes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, J., Constantino, M. & Yue, D.K. Morbidity and Mortality in Young-Onset Type 2 Diabetes in Comparison to Type 1 Diabetes: Where Are We Now?. Curr Diab Rep 15, 566 (2015). https://doi.org/10.1007/s11892-014-0566-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-014-0566-1

Keywords

Navigation