title: Prospective study on the incidences of cardiovascular-renal complications in Chinese patients with young-onset type 1 and type 2 diabetes.
abstract: OBJECTIVE We examined metabolic profiles and cardiovascular-renal outcomes in a prospective cohort of Chinese patients with young-onset diabetes defined by diagnosis age <40 years. Patients with type 1 diabetes and normal-weight (BMI <23 kg/m(2)) and overweight (BMI ≥23 kg/m(2)) patients with type 2 diabetes were compared. RESEARCH DESIGN AND METHODS Between 1995 and 2004, 2,323 patients (type 1 diabetes, n = 209; normal-weight type 2 diabetes, n = 636; and overweight type 2 diabetes, n = 1,478) underwent detailed clinical assessment. Incident cardiovascular disease (CVD) including coronary heart disease, stroke, and peripheral vascular disease were identified using hospital discharge diagnoses. End-stage renal disease (ESRD) was defined by glomerular filtration rate <15 mL/min/1.73 m(2) or dialysis. RESULTS Overweight patients with type 2 diabetes had the worst metabolic profile and highest prevalence of microvascular complications. Over a median follow-up of 9.3 years, incidences of CVD were 0.6, 5.1, and 9.6 per 1,000 person-years in patients with type 1 diabetes, normal-weight patients with type 2 diabetes, and overweight patients with type 2 diabetes. The respective figures for ESRD were 2.2, 6.4, and 8.4 per 1,000 person-years. Compared with type 1 diabetes, the overweight type 2 diabetes group had a greater hazard of progression to CVD (hazard ratio [HR] 15.3 [95% CI 2.1-112.4]) and ESRD (HR 5.4 [95% CI 1.8-15.9]), adjusted for age, sex, and disease duration. The association became nonsignificant upon additional adjustment for BMI, blood pressure, and lipid. CONCLUSIONS Young patients with type 2 diabetes had greater risks of developing cardiovascular-renal complications compared with patients with type 1 diabetes. The increased risk was driven primarily by accompanying metabolic risk factors.
authors.affiliation: Corresponding author: Juliana C.N. Chan, jchan@cuhk.edu.hk.
authors.forename: Andrea O Y
authors.initials: AO
authors.lastname: Luk
authors.forename: Eric S H
authors.initials: ES
authors.lastname: Lau
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.forename: Alice P S
authors.initials: AP
authors.lastname: Kong
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.forename: Francis C C
authors.initials: FC
authors.lastname: Chow
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D050171:Dyslipidemias / Q000150:complications / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult