Eppens Maike C, Craig Maria E, Cusumano Janine, Hing Stephen, Chan Albert K F, Howard Neville J, Silink Martin, Donaghue Kim C
University of Leiden, Leiden, the Netherlands.
Diabetes Care. 2006 Jun;29(6):1300-6. doi: 10.2337/dc05-2470.
To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.
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.
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 1 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 1 diabetes, while only higher A1C (1.7 [1.3-2.9], P = 0.002) was significant in patients with type 2 diabetes.
Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type 1 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.
比较1型糖尿病与2型糖尿病青少年患者糖尿病并发症的患病率及其危险因素。
我们对来自澳大利亚新南威尔士州的1433例1型糖尿病患者和68例年龄<18岁的2型糖尿病患者进行了一项基于临床的比较研究。通过七视野立体视网膜摄影评估视网膜病变；通过连续3次定时过夜尿液收集评估白蛋白排泄率；通过热觉和振动阈值评估周围神经病变；通过瞳孔测量评估自主神经病变。对所有患者测量糖化血红蛋白（HbA1c）（A1C）和血脂，对2型糖尿病患者测量C肽。
1型糖尿病患者与2型糖尿病患者相比，年龄中位数（四分位间距）分别为15.7岁（13.9 - 17.0）和15.3岁（13.6 - 16.4）（P = 0.2），而糖尿病病程中位数分别为6.8年（4.7 - 9.6）和1.3年（0.6 - 3.1）（P < 0.0001）。视网膜病变在1型糖尿病患者中明显更常见（20%对4%，P = 0.04），而微量白蛋白尿和高血压则明显较少见（1型糖尿病患者中分别为6%和16%，2型糖尿病患者中分别为28%和36%）。周围神经病变和自主神经病变的发生率相似（1型糖尿病患者中分别为27%和61%，2型糖尿病患者中分别为21%和57%）。在多变量分析中，1型糖尿病患者微量白蛋白尿与年龄较大（比值比1.3 [95%可信区间1.2 - 1.5]，P < 0.001）和收缩期高血压（3.63 [2.0 - 6.3]，P < 0.001）显著相关，而在2型糖尿病患者中只有较高的A1C（1.7 [1.3 - 2.9]，P = 0.002）具有显著意义。
2型糖尿病青少年患者微量白蛋白尿和高血压的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且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控制血糖的建议。
