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Adult Complications of Childhood-Onset Type 1 Diabetes Vary With Age at Diagnosis: A Population-Based Study
Timothy C Nielsen1,2, Samantha J Lain1,2,3, Maria E Craig2,4,5
1The Leeder Centre for Health Policy, Economics and Data, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Children with type 1 diabetes diagnosed before age 7 experienced fewer long-term complications within 20 years. Early-onset type 1 diabetes appears to have a slower progression to chronic complications.
Area of Science:
- Pediatric Endocrinology
- Diabetology
- Public Health
Background:
- Childhood-onset type 1 diabetes (T1D) carries risks for long-term complications.
- Understanding how age at diagnosis influences complication development is crucial for patient management.
Purpose of the Study:
- To investigate the incidence of long-term complications in individuals with childhood-onset T1D.
- To determine the impact of age at diabetes diagnosis on the risk and timing of complication development.
Main Methods:
- A cohort of 5,202 individuals diagnosed with T1D before age 16 in New South Wales, Australia (1990-2009) was analyzed.
- Data linkage with hospital, emergency, insurance, and death records (2001-2019) identified complications.
- Cox regression models assessed complication risk based on age at onset (<7, 7-<13, 13-<16 years) and diabetes duration.
Main Results:
- Onset at age <7 years was associated with a significantly lower 20-year risk for cardiac complications, severe retinopathy, lower-limb vascular issues, peripheral neuropathy, and kidney complications compared to onset at 13-<16 years.
- Incidence rates within 20 years post-onset ranged from 9.2/10,000 person-years (cardiac) to 53.4/10,000 person-years (kidney).
- No significant difference in complication risk was observed based on attained age (16-34 years).
Conclusions:
- Childhood-onset T1D diagnosed at age <7 years is linked to a reduced risk of chronic complications in the initial 20 years post-diagnosis.
- Prepubertal onset of T1D may be associated with a slower progression to the development of long-term diabetes-related complications.
Objective:
To examine incidence of long-term complications among people with childhood-onset type 1 diabetes, focusing on age at diabetes onset.
Research Design And Methods:
A registry of children diagnosed with type 1 diabetes aged <16 years in New South Wales, Australia, between 1990 and 2009 linked to hospital, emergency department, public insurance, and death data from 2001 to 2019 to identify complications. Age at onset was categorized as <7 years, 7 to <13 years, and 13 to <16 years. Incidence rates and hazard ratios (HR), with 95% CI, for the risk of complications, were calculated from multivariable Cox regression models by 1) duration of diabetes 0 to <20 years and 2) attained age of 16-34 years, with HR adjusted for diagnosis year, sociodemographics, and acute diabetes complications.
Results:
Of 5,202 people identified, 1,694 (32.6%) were diagnosed at age <7 years, 2,538 (48.8%) age 7 to <13 years, and 970 (18.6%) age 13 to <16 years. Within 20 years of onset, incidence ranged from 9.2 per 10,000 person-years (95% CI 7.2, 11.7) for cardiac complications to 53.4 per 10,000 person-years (95% CI 48.2, 59.0) for kidney complications. Diabetes onset at age <7 years (vs. 13 to <16 years) was associated with lower 20-year risk of complications, except lower-limb infections; cardiac adjusted HR (aHR) was 0.32 (95% CI 0.15, 0.66), severe retinopathy aHR was 0.25 (0.17, 0.36), lower-limb vascular complications aHR was 0.41 (0.24, 0.69), peripheral neuropathy aHR was 0.16 (0.08, 0.32), and kidney complications aHR was 0.40 (0.30, 0.53). Risk of complications did not differ by attained age.
Conclusions:
Children with type 1 diabetes onset at age <7 years had lower chronic complication risk in the first 20 years postdiagnosis, supporting a slower time to develop complications with prepubertal onset.
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