Children and adolescents with type 1 and type 2 diabetes mellitus in the Pediatric Diabetes Consortium Registries: comparing clinical characteristics and glycaemic control

• Published in: Diabetic medicine Vol. 37; no. 5; pp. 863 - 867
• Main Authors: Van Name, M. A., Cheng, P., Gal, R. L., Kollman, C., Lynch, J., Nelson, B., Tamborlane, W. V.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2020
• Subjects: Adolescents; Body weight; Children; Consortia; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetic ketoacidosis; Diagnosis; Insulin; Insulin secretion; Ketoacidosis; Overweight; Pediatrics; Risk factors; Teenagers
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14233

Aim
To compare the characteristics of children and adolescents with type 1 vs. type 2 diabetes in the Pediatric Diabetes Consortium (PDC) registries.
Methods
Participants were 10 to < 21 years of age at diagnosis; there were 484 with type 1 diabetes and 1236 with type 2 diabetes.
Results
Children and adolescents with type 2 diabetes were more likely to be female, overweight/obese, and from low‐income, minority ethnic families. Children and adolescents with type 1 diabetes were more likely to present with diabetic ketoacidosis and have higher mean HbA1c levels at diagnosis. More than 70% in both cohorts achieved target HbA1c levels < 58 mmol/mol (< 7.5%) within 6 months, but fewer participants with type 1 than type 2 diabetes were able to maintain target HbA1c levels after 6 months consistently throughout 3 years post diagnosis. Of the 401 participants with type 2 diabetes with ≥ 24 months diabetes duration on enrolment in the registry, 47% required no insulin treatment. Median C‐peptide levels were 1.43 mmol/l in the subset of participants with type 2 diabetes in whom it was measured, but only 0.06 mmol/l in the subset with type 1 diabetes.
Conclusions
Although families of children and adolescents with type 2 diabetes face greater socio‐economic obstacles and risk factors for poor diabetes outcomes, the greater retention of residual endogenous insulin secretion likely contributes to the increased ability of children and adolescents with type 2 diabetes to maintain target HbA1c during the first 3 years of diabetes diagnosis.
What's new?
Demographic and anthropometric characteristics differ between children and adolescents with type 1 and type 2 diabetes in the Pediatric Diabetes Consortium Registries.
Although a large percentage of older children and adolescents with type 1 and type 2 diabetes are able to achieve target HbA1c levels after 6 months of treatment, children and adolescents with type 2 diabetes are more likely to maintain glycaemic control than those with type 1 diabetes in the years after diagnosis, despite greater socio‐economic obstacles and risk factors.
More intensive treatment strategies are needed to maintain target HbA1c levels in older children and adolescents with type 1 diabetes after the initial 6‐month honeymoon period.