Kids with T2D face dreadful complications

Children with type 2 diabetes (T2D) face a strikingly high complication rate as they become young adults, with an 80 percent incidence of at least one vascular complication, as shown in the TODAY* study.

After 15 years of follow-up, arterial stiffness and worsened cardiac function were likely features in these children within 2–5 years of T2D diagnosis, said Dr Rachelle Gandica, a pediatric endocrinologist at Columbia University Medical Center in New York City, New York, US. [ADA 2023, session CT-1.5-SY25]

“Both events appear driven in part by hypertension and worsening A_1c levels.”

In this US study of 699 children with diabetes, the overall cardiovascular event rate was 3.7 per 1,000 patient-years in those who had just reached an average age of 26 years, with T2D of more than 13 years.

Overall, an HbA_1c of > 6.2 percent at study entry could tell that treatment will likely fail, said Gandica. “If a child’s A_1c is higher than 6.2 percent they will fail, and you have to watch for that.”

During follow-up, there were six cases of congestive heart failure, four cases of myocardial infarction, four strokes, and three cases of coronary artery disease. Hypertension went up from a prevalence of 19 percent at baseline to 68 percent by the end of follow-up.

The children were on average at least 14 years old at study entry, with diabetes that had been diagnosed for about 8 months, and then followed up for an average of 12.6 years.

At follow-up, 49 percent of the cohort had developed diabetic retinopathy, with 3.5 percent having macular oedema. The prevalence of diabetic nephropathy went up from 8 percent at study entry to 55 percent after up to 14 years of follow-up.

Of 141 patients who became pregnant, a quarter had preterm deliveries and 25 percent had a miscarriage or foetal demise. Complications in their babies include hypoglycaemia, respiratory disorder, and cardiac issues.

Gandica said the results suggest that diabetes in children may have a different underlying pathology and natural history than adults, with a more aggressive disease course that merits aggressive management. “Another important takeaway from TODAY is the importance of A_1c as a risk marker for impending treatment failure,” she added.