Endocrine Abstracts

Introduction: Diabetes mellitus (DM) is a chronic disease with increasing incidence worldwide, mostly in younger ages. Diabetic kidney disease (DKD) is a main complication, with a prevalence of 20-40%, associated with high cardiovascular mortality. Despite the association of type 2 diabetes (T2D) in young adults with rapid progression to DKD, in type 1 diabetes (T1D) this is not well established. Other complications have also a high impact on life quality.

Objective: Evaluate the difference in the metabolic control and incidence of complications associated with T1D and T2D in young adults.

Methods: Retrospective cohort study including all cases of patients with DM aged 16 to 25 who attended MYAHC (Mater Young Adult Health Centre, Brisbane), between 2016-2020. Cases with less than 2 GFR measurements were excluded. Values of glycated haemoglobin (HgA1c) were collected.

Results: Were analysed 576 patients, 548 with T1D and 28 with T2D. In total, 59% were female, the mean age at first visit was 19.3 and the median time since diagnosis was 16 years. CKD of diabetic aetiology was found in 14.4% of T1D group, 2 of them with ESKD (0.3%), compared with 71.4% in T2D group, none with end-stage kidney disease (ESKD). Cases of CKD of another aetiology were found only in T2D group (10.7%). GFR was lower than 90 ml/min/1.73 m² in 19.9% of T1D group, compared to 7.1% in T2D group. GFR below 60ml/min/1.73 m² was only found in 0.7% of T1D group. Overall, the decrease in GFR per year was an average of 2.11 ml/min/1.73 m² in T1D group compared to 0.98 ml/min/1.73 m² in T2D group. For other chronic complications: peripheral neuropathy was found only in T1D group (3.1%); 12.2% of T1D presented with retinopathy compared to 7.1% in T2D group; autonomic neuropathy was present in 64.3% of T2D group, compared with 2.2% in T1D group. Better metabolic control was noted in T2D, with a HgA1c of 7.2 compared to 7.8 in T1D group.

Conclusion: Regardless higher incidence of DKD in the T2D group, there was higher incidence of ESRD along with greater decline in eGFR/year in T1D group. Also, overall incidence of other complications was higher in T1D. Although these can possibly be explained by the small number of young people diagnosed with T2D, these results suggests that the progression rate towards DKD is higher and more abrupt in young adults with T1D. Better metabolic control in T2D reinforces the importance of intensive treatment in T1D.