ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This longitudinal observational study combined data from the SEARCH (T1D: N=564; T2D: N=149) and TODAY studies (T2D: N=495). Complications were higher in those with childhood onset T2D compared to T1D, with T2D showing 2.5 to 4 times higher rates of microvascular, macrovascular events despite similar diabetes duration. Risk factors for complications differed between T2D and T1D, with mean arterial pressure being a common predictor for both.

Comment: The SEARCH for Diabetes in Youth (SEARCH) study is an observational study initiated in 2000 at five sites across the U.S., designed to estimate the prevalence, incidence, and complications of both T1D and T2D in youth. The Treatment Options for T2D in Adolescents and Youth (TODAY(study is an interventional study focused specifically on adolescents with T2D aiming to compare the effectiveness of different treatment options for managing the disease in this age group. Here, the researchers combined data from these 2 studies to assess rates of micro- and macrovascular complications in 564 youth-onset T1D and 644 youth-onset T2D, creating the largest sample of its kind in children. It also assessed rates of medical events related to inflammation and insulin resistance, including venous thrombosis, pancreatitis, gallbladder disease, and cirrhosis.

Mean age at assessment ranged between 21 and 26 years, and mean disease duration was 11-13 years. All complications were higher in youth with T2D than T1D. Individuals with youth-onset T2D developed micro- or macrovascular disease earlier in their disease course, starting about 8 years after diagnosis. In youth-onset T2D, blood pressure was the sole predictor of both micro- and macrovascular disease. In another recent study, of 196 participants with youth-onset T2D and hypertension or nephropathy, 157 (80.1%) had low adherence.¹ Of participants with low adherence, 106 (67.52%) were not using any blood pressure-lowering medication.

These data emphasize the need for a proactive and assertive approach to prevent the complications associated with T2D in adolescents.

Reference: 1. Weinstock RS, Trief PM, Burke BK, Wen H, Liu X, Kalichman S, Anderson BJ, Bulger JD. Antihypertensive and Lipid-Lowering Medication Adherence in Young Adults With Youth-Onset Type 2 Diabetes. JAMA Netw Open. 2023 Oct 2;6(10):e2336964. doi:10.1001/jamanetworkopen.2023.36964.