Microvascular and Macrovascular Complications in Young-onset Type 2 Diabetes in a Tertiary Health Institution in Malaysia in Comparison with Type 1 Diabetes Patients
Keywords:
young- onset type 2 diabetes, diabetic complications, type 1 diabetesAbstract
*Visual Abstracts prepared by Dr. Carmen Carina CabreraObjectives: To compare the rate of diabetes complications in young-onset type 2 diabetes (T2DM) with type 1 diabetes (T1DM) patients and to examine the relationship between diabetes complications with clinical and metabolic parameters.
Methodology: This is a retrospective,comparative study based on electronic medical records review. Young-onset T2DM patients defined as those with disease onset before the age of 40 and T1DM patients were included. Data was collected on demographic and clinical parameters, cardiovascular risks factors, macrovascular and microvascular complications.
Results: There were 194 young-onset T2DM and 45 T1DM subjects. Despite similar glycemic profile, more subjects in the T2DM group hadunfavourable cardiovascular risk factors and developedmacro- or microvascular complications than the T1DM group (22 vs. 0%, p< 0.001for macrovascular, 68 vs. 40%, p< 0.001 for microvascular). Afteradjustment ofthe confounders, young-onset T2DM remained an independent predictor for both macrovascular and microvascular complications in the overall cohort (HR= 2.635, p= 0.022).
Conclusion:Young-onset T2DM appeared to be a more aggressive disease compared to T1DM. An aggressive approach should be adopted in treating young-onset T2DM to optimise the cardiovascular risk factors and glycemic control to prevent premature mortality and morbidity.
Downloads
References
Wilmot EG, Idris I. Early onset type 2 diabetes: Risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234-44. https://doi.org/ 10.1177/2040622314548679.
The SEARCH Study Group. SEARCH for diabetes in youth: A multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin Trials. 2004;25(5):458–71. https://doi.org/10.1016/j.cct.2004.08.002.
TODAY Study Group. A clinical trial to maintain glycaemic control in youth with type 2 diabetes. N Engl J Med. 2012;366:2247–56. https://doi.org/10.1056/NEJMoa1109333.
Song HS. Complication characteristics between young-onset type 2 versus type 1 diabetes in a UK population. BMJ Open Diab Res Care. 2015;3(1):e000044. https://doi.org/10.1136/bmjdrc-2014-000044.
Constantino MI, Molyneaux L, Limacher-Gisler F, et al. Long-term complications and mortality in young-onset diabetes. Diabetes Care. 2013. 36(12):3863-9. https://doi.org/10.2337/dc12-2455.
Scottish Intercollegiate Guidelines Network: Diagnosis and management of chronic kidney disease: A national clinical guideline. 2008. Available in http://www.sign.ac.uk/pdf/sign103.pdf.
Penno G, Solini A, Zoppini G, Fondelli C, et al. Hypertriglyceridemia is independently associated with renal, but not retinal complications in subjects with type 2 diabetes: A cross-sectional analysis of the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study. PLoS One. 2015;10(5): e1025512. https://doi.org/10.1371/ journal.pone.0125512.
Smith AG, Singleton JR. Obesity and hyperlipidemia are risk factors for early neuropathy. J Diabetes Complications. 2013;27(5):436-42. https://doi.org/10.1016/j.jdiacomp.2013.04.003.
Ziegler D, Rathmann W, Dickhaus T, Meisinger C, et al. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy. Diabetes Care. 2008;31(3):464-9. https://doi.org/10.2337/dc07-1796.
Mafauzy M, Hussein Z, Chan SP. The status of diabetes control in Malaysia: Results of DiabCare 2008. Med J Malaysia 2011;66(3):175-81. PMID: 22111435.
Yeung RO, Zhang Y, Luk A, et al. Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): A cross-sectional study of a prospective cohort. The Lancet. 2014;2(12):935-43. https://doi.org/10.1016/S2213-8587(14)70137-8.
Foo SH, Chan SP, Bahari IS, Bulgiba A. Insulin resistance is the predominant pathophysiologic feature of hyperglycaemia in newly diagnosed overweight and obese type 2 diabetes mellitus in two university hospitals in Malaysia. J ASEAN Fed Endocr Soc. 2011;26(2):143-9. https://doi.org/10.15605/jafes.026.02.12.
The second to fifth National Health Morbidity Survey (NHMS II-V), Ministry of Health, Malaysia. 1996, 2006, 2011 and 2015.
Linder BL, Fradkin JE, Rodgers GP. The TODAY Study: An NIH Perspective on its implications for research. Diabetes Care. 2013;36(6):1775-6. https://doi.org/10.2337/dc13-0707.
The HAPO Study Cooperative Research Group. Hyperglycaemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002. https://doi.org/ 10.1056/NEJMoa0707943.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.