Type 2 diabetes produces more severe complications than type 1

Adapted from BMJ 11 March 2017

In an observational study reported in JAMA 1,746 type one patients were compared with 272 type two patients. All had developed their diabetes before the age of 20. My comment: It is not clear whether the duration of diabetes was adjusted for, as the onset of type one diabetes tends to cluster around puberty, although it can occur as early as soon after birth, and the onset of type two diabetes tends to arise in later teenage years. Thus if average 30 year olds were compared head to head in the study, for instance, one would expect the type 1 patients to have more complications purely based on having had the condition much longer on average than the type 2s.

Nevertheless, the prevalence of diabetic kidney disease, retinopathy and peripheral neuropathy was significantly greater in the type two group compared to the type one group, even after they adjusted for differences in glycated haemoglobin, body mass index, waist to height ratio, and mean arterial blood pressure.

This study provides information that early age of onset of type 2 diabetes is a real problem, as once established, it does a lot of damage, that is difficult to control with standard therapies.