SEARCH reported a high burden of early complications in type 1 diabetes (T1DM). We examined co-occurrence of complications and related risk factors among 1327 SEARCH T1DM participants aged 10-30 years. Risk factors were assessed at baseline (mean diabetes duration and age = 0.8 and 10.9 years, respectively) and follow-up (7.8 and 18.0 years, respectively). Retinopathy (RET), diabetic kidney disease (DKD), peripheral neuropathy, cardiovascular autonomic neuropathy (CAN), and arterial stiffness (AS) were assessed at follow-up. We examined co-occurrence of ≥2 complications overall, by type, and within four demographic/metabolic risk factor clusters identified using cluster analysis. Clusters were characterized by worsening risk profiles (Table). Co-occurrence of ≥2 complications was observed in 5.9% of participants, more frequently than expected by chance (4.4%, p=0.02). Specifically, RET+DKD (0.83% vs. 0.23%), RET+AS (0.98% vs. 0.34%), and AS+CAN (1.81% vs. 1.04%) all co-occurred more frequently (all p<0.05). Prevalence of ≥2 complications increased across risk clusters from 2.3% to 20.8%.
Selected characteristics and prevalence of 2+ complications at follow-up by risk factor clusters
| Cluster 1 (n=261) | Cluster 2 (n=509) | Cluster 3 (n=348) | Cluster 4 (n=24) | p-value | |
| NHW (n, %) | 217 (83.1) | 395 (77.6) | 257 (73.9) | 15 (62.5) | 0.002 |
| Private insurance (n, %) | 211 (80.8) | 386 (76.1) | 222 (64.2) | 9 (37.5) | <0.001 |
| A1c (%) | 8.5 ± 1.5 | 9.0 ± 1.7 | 9.7 ± 1.9 | 11.8 ± 2.0 | <0.001 |
| Non-HDLc (mg/dl) | 79.0 ± 12.9 | 105.7 ± 12.2 | 147.9 ± 21.5 | 245.5 ± 33.5 | <0.001 |
| Waist to height ratio | 0.44 ± 0.05 | 0.46 ± 0.06 | 0.49 ± 0.07 | 0.50 ± 0.05 | <0.001 |
| Mean arterial pressure (mmHg) | 80.0 ± 8.0 | 82.6 ± 8.6 | 82.4 ± 8.4 | 84.4 ± 10.1 | <0.001 |
| ≥2 complications (n, %) | 6 (2.3) | 32 (6.3) | 28 (8.0) | 5 (20.8) | <0.001 |
| Cluster 1 (n=261) | Cluster 2 (n=509) | Cluster 3 (n=348) | Cluster 4 (n=24) | p-value | |
| NHW (n, %) | 217 (83.1) | 395 (77.6) | 257 (73.9) | 15 (62.5) | 0.002 |
| Private insurance (n, %) | 211 (80.8) | 386 (76.1) | 222 (64.2) | 9 (37.5) | <0.001 |
| A1c (%) | 8.5 ± 1.5 | 9.0 ± 1.7 | 9.7 ± 1.9 | 11.8 ± 2.0 | <0.001 |
| Non-HDLc (mg/dl) | 79.0 ± 12.9 | 105.7 ± 12.2 | 147.9 ± 21.5 | 245.5 ± 33.5 | <0.001 |
| Waist to height ratio | 0.44 ± 0.05 | 0.46 ± 0.06 | 0.49 ± 0.07 | 0.50 ± 0.05 | <0.001 |
| Mean arterial pressure (mmHg) | 80.0 ± 8.0 | 82.6 ± 8.6 | 82.4 ± 8.4 | 84.4 ± 10.1 | <0.001 |
| ≥2 complications (n, %) | 6 (2.3) | 32 (6.3) | 28 (8.0) | 5 (20.8) | <0.001 |
In conclusion, early T1DM complications co-occur more frequently than expected, at a young age and short diabetes duration. A cluster of risk factors including minority race/ethnicity, lack of private insurance, and poor metabolic profiles identifies groups to target with interventions to reduce complications.
K.A. Sauder: None. J.M. Stafford: None. E.J. Mayer-Davis: None. E.T. Jensen: None. S. Saydah: None. A.K. Mottl: None. L.M. Dolan: None. R.F. Hamman: None. J.M. Lawrence: None. C. Pihoker: None. S.M. Marcovina: None. R. Dagostino: Consultant; Self; Teva Pharmaceutical Industries Ltd., Acelity, RedHill Biopharma, Edwards Lifesciences. D. Dabelea: None.
