title: Earlier onset of complications in youth with type 2 diabetes.
abstract: OBJECTIVE
  To evaluate the risk of complications in youth with type 2 diabetes.
  
  
  METHODS
  Population-based cohorts of 342 youth (1-18 years of age) with prevalent type 2 diabetes, 1,011 youth with type 1 diabetes, and 1,710 nondiabetic control youth were identified between 1986 and 2007 from a clinical registry and linked to health care records to assess long-term outcomes using ICD-9CM and ICD-10CA codes.
  
  
  RESULTS
  Youth with type 2 diabetes had an increased risk of any complication (hazard ratio 1.47 [95% CI 1.02-2.12]). Significant adverse clinical factors included age at diagnosis (1.08 [1.02-2.12]), HbA1c (1.06 [1.01-1.12]), and, surprisingly, renin-angiotensin-aldosterone system (RAAS) inhibitor use (1.75 [1.27-2.41]). HNF-1α G319S polymorphism was protective in the type 2 diabetes cohort (0.58 [0.34-0.99]). Kaplan-Meier statistics revealed an earlier diagnosis of renal and neurologic complications in the type 2 diabetes cohort, manifesting within 5 years of diagnosis. No difference in retinopathy was seen. Cardiovascular and cerebrovascular diseases were rare; however, major complications (dialysis, blindness, or amputation) started to manifest 10 years after diagnosis in the type 2 diabetes cohort. Youth with type 2 diabetes had higher rates of all outcomes than nondiabetic control youth and an overall 6.15-fold increased risk of any vascular disease.
  
  
  CONCLUSIONS
  Youth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes. Younger age at diagnosis is potentially protective, and glycemic control is an important modifiable risk factor. The unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication; however, further evaluation in young people is warranted.
authors.affiliation: Corresponding author: Allison B. Dart, adart@hsc.mb.ca.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Dart
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Marni D
authors.initials: MD
authors.lastname: Brownell
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Dean
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sellers
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D055815:Young Adult