More comorbidities and complications with Type 2 diabetes versus Type 1

By Lisa Foster-McNulty, MSN, RN, CDE

Doesn’t it irk you when someone remarks, upon learning that you have Type 1 diabetes, that you have “the bad kind”?  There seems to be a concept out there that Type 2 is “the good kind” of diabetes.  Seriously, is there any form of diabetes that is desirable to have? 

Recent research published in JAMA showed that diabetes complications and comorbidities happened more often in adolescents and young adults with Type 2 diabetes, in contrast with study participants who had a diagnosis of Type 1 diabetes.  Comorbidities are other chronic diseases that occur alongside, in this case, diabetes.

One of the study investigators was Dana Dabelea, MD, PhD, from the Colorado School of Public Health.  She discussed that in spite of being young and having had a diabetes diagnosis for just under eight years, complications and comorbidities did occur in the study participants.  Compared to those with Type 1, the Type 2 patients and those belonging to minority ethnic groups actually had a higher prevalence of these problems.  This group needs aggressive control of risk factors.

Providers need to make sure that the standards of care set forth by the American Diabetes Association (ADA) for monitoring patient A1c, cholesterol levels, protein in the urine, and blood pressure (BP) are followed.  Medication regimens need to be adjusted to optimize blood glucose control.  If blood pressure or cholesterol levels are too high, medications to address this should be started at an earlier age.  Emphasizing a lifestyle approach, providers need to address weight management and advocate for weight loss when needed.   

This study used data from the SEARCH for Diabetes in Youth registry.  These young people were diagnosed with diabetes before the age of 20.  Researchers looked at both the prevalence of and risk factors for complications stemming from Type 1 and Type 2 diabetes.  The mean age of the study participants at diagnosis was 14.2 years for Type 2s and 10 years for Type 1s.  The mean age at the outcome visit was 22.1 years versus 17.9 years, respectively.  For both groups, the duration of diabetes was 7.9 years at the outcome visit.

Type 2 study subjects had higher values for obesity and mean arterial pressure, and they had a higher incidence of complications and comorbidities as compared with the Type 1 participants.  Prevalence of diabetic kidney disease was higher in the Type 2 group (19.9%), as compared to the Type 1 subjects (5.8%).  Type 2 participants also had a higher incidence of diabetic retinopathy (diabetic eye disease) and peripheral neuropathy (nerve damage).

The authors concluded that in both types of diabetes, at a young age, and at less than eight years after diagnosis, the prevalence of diabetes-related complications and comorbidities was high.  As if this isn’t unfortunate enough, young people with Type 2 and minority youths were disproportionately affected.

While the news isn’t good, it does give us a wake-up call.  No one is immune to the effects of diabetes, and it is so important to keep BG levels (along with cholesterol and BP) as normal as possible.