Background: Few studies reported incidence rates of late-stage complications in people with youth-onset type 2 diabetes. We compared the clinical characteristics and incidence of cardiovascular disease (CVD) , end-stage kidney disease (ESKD) and death in a cohort of Chinese youth with type 2 and type 1 diabetes.

Method: We performed a retrospective analysis of 1221 people with type 2 diabetes and 641 with type 1 diabetes diagnosed at age <20 years who underwent metabolic and complication assessment in Hong Kong Hospital Authority between 2000-2019, followed for incident CVD, ESKD and all-cause death until 2019. Cox regression models were used to determine the hazards of complications in type 2 versus type 1 diabetes.

Result: At baseline, people with youth-onset type 2 diabetes were older at diagnosis (16 [14-18] vs. [8-15] years, p<0.01) but had similar diabetes duration (6 [2-15] vs. 6 [2-13] years, p=0.32) to those with type 1 diabetes. People with type 2 diabetes had higher frequency of obesity (71.3% vs. 14.6%) , hypertension (48.3% vs. 21.0%) , dyslipidemia (58.8% vs 24.1%) and albuminuria (29.8% vs. 11.2%) (p<0.01) . Over a median follow-up of 6.7-7.8 years, incidence rates (per 1000 person-year [95% CI]) , were 5.3 (3.9-7.0) vs. 1.4 (0.6-2.9) for CVD, 8.1 (6.4-10.1) vs. 2.4 (1.3-4.2) for ESKD, and 6.9 (5.4-8.7) vs. 2.6 (1.4-4.4) for death in people with type 2 and type 1 diabetes, respectively (p<0.01) . With reference to type 1 diabetes, the risks of CVD (HR [95% CI] 2.6 [1.1-6.2]) and ESKD (HR 2.4 [1.2-4.5]) but not death (HR 1.6 [0.8-2.9]) were higher in type 2 diabetes, adjusted for age at diagnosis, diabetes duration and sex. The increased hazard for ESKD but not CVD remained after further adjustment for smoking, glycaemic and metabolic control.

Conclusion: People with youth-onset type 2 diabetes had 2-fold increased risk of CVD and ESKD, in part driven by greater burden of obesity and other metabolic risk factors in this group.


Y.Fan: None. E.S.H.Lau: None. H.Wu: None. A.Yang: None. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Other Relationship; AstraZeneca, Novo Nordisk, Research Support; Boehringer Ingelheim, Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi, Stock/Shareholder; Aptorum Group Limited. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp & Dohme Corp., Roche Diabetes Care, Viatris Inc., Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories, Stock/Shareholder; GemVCare Ltd. A.Luk: None.

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