Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

POSTER DISCUSSION: Impact of adiposity and albuminuria on outcomes in young adult onset type 2 diabetes (#223)

Maria Constantino 1 2 , Timothy Middleton 1 2 , Mario D'Souza 3 , Lynda Molyneaux 1 , Stephen M Twigg 1 2 , Ted Wu 1 , Jencia Wong 1 2
  1. Diabetes Centre , Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
  3. Clinical Research Centre, Sydney Local Health District, Sydney, NSW, Australia

Higher mortality in young adult onset type 2 diabetes (YT2DM, diagnosed 15-29 years) compared to type 1 diabetes (T1DM) diagnosed at a similar age has been shown. Albuminuria and adiposity related factors are likely to contribute to these differences in outcome.  However, as overweight and obesity rates in T1D are now high, we examined if the excess mortality seen in YT2D persists when compared to T1D in the setting of increased BMI or albuminuria.  Standardized mortality rates (SMR) against the Australian population for 455 T1D and 6163 T2D patients from the RPA Hospital, Sydney were derived and stratified by age of onset. The effect of ever having albuminuria or a BMI >25kg/m2 on SMR in T1D and T2D were compared in separate Poisson regression models.  Adjustments were made for HbA1c, blood pressure, cholesterol, smoking and macrovascular disease.  SMR for T1D was increased in the presence of albuminuria as for T2D (p=0.14). Further, albuminuria increased the SMR in T1D to be similar to that of YT2D (Fig 1a) at any given age.  In contrast, SMR for T2D patients with BMI >25kg/m2 was not significantly different from normal weight T2D patients (p=0.81).  The overall effect of increased BMI was not different between T2D and T1D (p=0.98); this was clearly seen within the young age of onset group (Fig 1b).  While prognosis is poorer in YT2D, those T1D subjects with a history of albuminuria do as poorly as their albuminuric YT2D counterparts. Obesity itself does not significantly modify SMR in either T2D or T1D.

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