Socioeconomic status and risk factors for complications in young people with type 1 or type 2 diabetes: a cross-sectional study. Issue 2 (30th December 2021)

• Record Type: Journal Article
• Authors: Wijayaratna, Sasini; Lee, Arier; Park, Hyun Young; Jo, Emmanuel; Wu, Fiona; Bagg, Warwick; Cundy, Tim
• Is Part Of: BMJ open diabetes research and care. Volume 9:Issue 2(2021)
• Publication Date: 2021-12-30
• Subjects: young adult -- diabetes mellitus -- type 2 -- poverty; Diabetes -- Periodicals; 616.462005
• DOI: 10.1136/bmjdrc-2021-002485
• Languages: English
• ISSNs: 2052-4897

Abstract

Abstract : Introduction: Young people with type 2 diabetes (T2D) develop complications earlier than those with type 1 diabetes (T1D) of comparable duration, but it is unclear why. This apparent difference in phenotype could relate to relative inequality. Research design and methods: Cross-sectional study of young people referred to secondary diabetes services in Auckland, Aotearoa-New Zealand (NZ): 731 with T1D and 1350 with T2D currently aged < 40 years, and diagnosed between 15 and 30 years. Outcome measures were risk factors for complications (glycemic control, urine albumin/creatinine ratio (ACR), cardiovascular disease (CVD) risk) in relation to a validated national index of deprivation (New Zealand Deprivation Index (NZDep)). Results: Young people with T2D were an average 3 years older than those with T1D but had a similar duration of diabetes. 71% of those with T2D were of Māori or Pasifika descent, compared with 24% with T1D (p<0.001). T1D cases were distributed evenly across NZDep categories. 78% of T2D cases were living in the lowest four NZDep categories (p<0.001). In both diabetes types, body mass index (BMI) increased progressively across the NZDep spectrum (p<0.002), as did mean glycated hemoglobin (HbA1c ) (p<0.001), the prevalence of macroalbuminuria (p≤0.01), and CVD risk (p<0.001). Adjusting for BMI, diabetes type, and duration and age, multiple logistic regression revealed deprivation was the strongest risk factor for poorly controlled diabetes (defined as HbA1c >64 mmol/mol, >8%); OR 1.17, 95% CI 1.13 to 1.22, p<0.0001. Ordinal logistic regression showed each decile increase in NZDep increased the odds of a higher ACR by 11% (OR 1.11, 95% CI 1.06 to 1.16, p<0.001) following adjustment for BMI, blood pressure, diabetes type and duration, HbA1c, and smoking status. Multiple linear regression indicated a 4% increase in CVD risk for every decile increase in NZDep, regardless of diabetes type. Conclusions: The apparent more aggressive phenotype of young-onset T2D is at least in part explicable by relative deprivation.