Co-occurrence of 2+ Early Complications in Type 1 Diabetes—SEARCH for Diabetes in Youth

Abstract

SEARCH reported a high burden of early complications in type 1 diabetes (T1DM). We examined co-occurrence of complications and related risk factors among 1327 SEARCH T1DM participants aged 10-30 years. Risk factors were assessed at baseline (mean diabetes duration and age = 0.8 and 10.9 years, respectively) and follow-up (7.8 and 18.0 years, respectively). Retinopathy (RET), diabetic kidney disease (DKD), peripheral neuropathy, cardiovascular autonomic neuropathy (CAN), and arterial stiffness (AS) were assessed at follow-up. We examined co-occurrence of ≥2 complications overall, by type, and within four demographic/metabolic risk factor clusters identified using cluster analysis. Clusters were characterized by worsening risk profiles (Table). Co-occurrence of ≥2 complications was observed in 5.9% of participants, more frequently than expected by chance (4.4%, p=0.02). Specifically, RET+DKD (0.83% vs. 0.23%), RET+AS (0.98% vs. 0.34%), and AS+CAN (1.81% vs. 1.04%) all co-occurred more frequently (all p<0.05). Prevalence of ≥2 complications increased across risk clusters from 2.3% to 20.8%. Selected characteristics and prevalence of 2+ complications at follow-up by risk factor clustersCluster 1 (n=261)Cluster 2 (n=509)Cluster 3 (n=348)Cluster 4 (n=24)p-valueNHW (n, %)217 (83.1)395 (77.6)257 (73.9)15 (62.5)0.002Private insurance (n, %)211 (80.8)386 (76.1)222 (64.2)9 (37.5)<0.001A1c (%)8.5 ± 1.59.0 ± 1.79.7 ± 1.911.8 ± 2.0<0.001Non-HDLc (mg/dl)79.0 ± 12.9105.7 ± 12.2147.9 ± 21.5245.5 ± 33.5<0.001Waist to height ratio0.44 ± 0.050.46 ± 0.060.49 ± 0.070.50 ± 0.05<0.001Mean arterial pressure (mmHg)80.0 ± 8.082.6 ± 8.682.4 ± 8.484.4 ± 10.1<0.001≥2 complications (n, %)6 (2.3)32 (6.3)28 (8.0)5 (20.8)<0.001 In conclusion, early T1DM complications co-occur more frequently than expected, at a young age and short diabetes duration. A cluster of risk factors including minority race/ethnicity, lack of private insurance, and poor metabolic profiles identifies groups to target with interventions to reduce complications. Disclosure K.A. Sauder: None. J.M. Stafford: None. E.J. Mayer-Davis: None. E.T. Jensen: None. S. Saydah: None. A.K. Mottl: None. L.M. Dolan: None. R.F. Hamman: None. J.M. Lawrence: None. C. Pihoker: None. S.M. Marcovina: None. R. Dagostino: Consultant; Self; Teva Pharmaceutical Industries Ltd., Acelity, RedHill Biopharma, Edwards Lifesciences. D. Dabelea: None.