The Changing Face of Young-Onset Diabetes: Type 1 Optimism Mellowed by Type 2 Concerns

Abstract

Until recently the outlook for a youth or young adult diagnosed with diabetes, which was almost universally type 1, was bleak. Indeed, using data from the National Health Interview Survey as recent as from 1984 to 2000, it was estimated that U.S. children diagnosed with diabetes at 10 years of age had a life expectancy approximately 19 years less than seen in the general population (1). However, more recent data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study suggest those diagnosed with childhood-onset diabetes between 1965 and 1980 have a life expectancy of almost 69 years, which is less than 4 years lower than the comparable U.S. population (2). This good news has been accompanied by the observation from the Finnish Diabetic Nephropathy (FinnDiane) study that virtually all of the excess mortality seen in type 1 diabetes is related to the development of micro- or macroalbuminuria (3). This seminal observation has been confirmed and extended for up to a 20-year period in the EDC population (4). The improved prognosis, in terms of mortality, has been accompanied by a dramatic reduction (5) or delay (6) in the incidence of end-stage renal disease. Interestingly, the decline in cardiovascular disease (CVD), the leading cause of overall mortality in diabetes, is less marked (5). One cautionary note, however, has to be made concerning the improvement in mortality of patients with type 1 diabetes. In a recent analysis of over 17,000 individuals in Finland, diagnosed between 1970 and 1999, Harjutsalo et al. (7) compared the time trends of mortality for those diagnosed at an age less than 15 years to those diagnosed at an age of 15 through 29 years. Although a very significant fall was seen in mortality over time for the young-onset group, consistent with the Pittsburgh EDC population (who were …