Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes
Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes
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DOI：
10.2337/dc05-2470
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发表时间：
2006-06-01
期刊：
影响因子：
16.2
通讯作者：
Donaghue, Kim C.
中科院分区：
文献类型：
--
作者：
Eppens, Maike C.;Craig, Maria E.;Donaghue, Kim C.
目的：比较青年1型和2型糖尿病患者糖尿病并发症的患病率及其危险因素。研究设计和方法：我们对来自澳大利亚新南威尔士州年龄< 18岁的1433例1型糖尿病患者和68例2型糖尿病患者进行了一项基于临床的比较研究。采用七视野立体视网膜摄影评估视网膜病变；连续三次定时、夜间尿液采集白蛋白排泄率；热、振动阈值周围神经病变；通过瞳孔测量法检测自主神经病变。在所有患者中测量HbA(1c) （A1C）和血脂，在2型糖尿病患者中测量c肽。结果：1型与2型糖尿病患者的中位年龄（四分位数间距）分别为15.7岁（13.9-17.0）和15.3岁（13.6-16.4）（P = 0.2），而中位糖尿病病程分别为6.8年（4.7-9.6）和1.3年（0.6-3.1）（P < 0.0001）。视网膜病变在I型糖尿病患者中更为常见（20% vs. 4%, P = 0.04），而微量白蛋白尿和高血压的发生率明显较低（1型糖尿病患者为6%和16%，2型糖尿病患者为28%和36%）。外周神经病变和自主神经病变的发生率相似（1型糖尿病为27%和61%，2型糖尿病为21%和57%）。在多变量分析中，微量白蛋白尿与1型糖尿病患者的年龄（比值比为1.3 [95% CI 1.2-1.5], P < 0.001）和收缩期高血压（比值比为3.63 [2.0-6.3],P < 0.001）显著相关，而2型糖尿病患者只有较高的A1C（比值比为1.7[1.3-2.9],P = 0.002）显著相关。结论：青年2型糖尿病患者的微量白蛋白尿和高血压发生率明显高于同龄1型糖尿病患者，尽管糖尿病病程较短，A1C较低。本研究结果支持对2型糖尿病患者进行早期并发症筛查和积极靶向血糖控制的建议。
OBJECTIVE - To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.RESEARCH DESIGN AND METHODS - We performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged < 18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoscopic retinal photography; albumin excretion rate from three consecutive, timed, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA(1c) (A1C) and lipids were measured in all patients and C-peptide in patients with type 2 diabetes.RESULTS - in patients with type 1 versus type 2 diabetes, median (interquartile range) age was 15.7 years (13.9-17.0) and 15.3 years (13.6-16.4), respectively (P = 0.2), whereas median diabetes duration was 6.8 years (4.7-9.6) and 1.3 years (0.6-3.1), respectively (P < 0.0001). Retinopathy was significantly more common in patients with type I diabetes (20 vs. 4%, P = 0.04), while microalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes), In multivariate analyses, microalbuminuria was significantly associated with older age (odds ratio 1.3 [95% CI 1.2-1.5], P < 0.001) and systolic hypertension (3.63 [2.0-6.3], P < 0.001) in type I diabetes, while only higher A1C (1.7[1.3-2.9], P = 0.002) was significant in patients with type 2 diabetes.CONCLUSIONS - Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type I diabetes, despite shorter diabetes duration and lower A1C. The results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes.