TOPLINE

Children diagnosed with type 1 diabetes (T1D) before age 7 years had a lower risk for chronic complications — including cardiac disease, severe retinopathy, other eye complications, lower-limb vascular disease, peripheral neuropathy, and kidney disease — in the first 20 years following diagnosis than those diagnosed at the age of 13 to < 16 years. However, by age 35 years, complication risk equalized across age groups for most outcomes — except kidney complications, where those diagnosed at the age of 7 to < 13 years retained a lower risk.

METHODOLOGY

• Previous studies suggested that prepubertal T1D onset may reduce the risk for retinopathy and kidney disease. However, these studies were small, used outdated treatment protocols, and rarely reported on cardiac or lower-limb complications, highlighting the need for updated studies with larger populations.
• Researchers conducted a cohort study using registry data linked to hospital, emergency department, insurance, and death records to examine the incidence of diabetes-related complications and whether age at T1D onset was associated with long-term complications.
• They analyzed data of 5202 children diagnosed with T1D before the age of 16 years, stratified by age at onset: younger than 7 years (n = 1694; 50.4% girls), 7 to < 13 years (n = 2538; 51.7% girls), and 13 to < 16 years (n = 970; 38.6% girls). T1D onset was defined as the date of the first insulin injection.
• The primary outcome was the first occurrence of each specific long-term diabetes complication, including cardiac complications, severe retinopathy, other eye complications, lower-limb vascular complications, lower-limb infections, lower-limb peripheral neuropathy, and kidney complications.
• The incidence rates for chronic complications were assessed both by diabetes duration (up to 20 years) and attained age during follow-up (16-34 years). The median follow-up time was 160-164 months on the diabetes duration timescale and 83-152 months on the attained age timescale, varying by age at diabetes onset.

TAKEAWAY

• Within 20 years of T1D onset, incidence rates overall ranged from 9.2 per 10,000 person-years for cardiac complications to 73.6 per 10,000 person-years for other eye complications.
• Compared with children with T1D onset at the age of 13 to < 16 years, those with T1D onset before the age of 7 years had a lower 20-year risk for cardiac complications (adjusted hazard ratio [aHR], 0.32), severe retinopathy (aHR, 0.25), other eye complications (aHR, 0.41), lower-limb vascular complications (aHR, 0.41), lower-limb peripheral neuropathy (aHR, 0.16), and kidney complications (aHR, 0.40).
• By the age of 35 years, the risk for chronic complications was similar across all age-at-T1D onset groups, except for kidney complications, where those diagnosed at 7 to < 13 years had a lower risk (aHR, 0.68) than those diagnosed at 13 to < 16 years.
• Individuals with two or more prior acute complication events had a substantially higher risk for chronic complications, ranging from nearly threefold (aHR, 2.86 for cardiac complications) to 11-fold (aHR, 11.23 for lower-limb peripheral neuropathy) than those without prior acute complications.

IN PRACTICE

“Those with diabetes diagnosed prior to age 7 years had a decreased risk of microvascular complications up to 20 years following diagnosis compared with those with diabetes diagnosed later in childhood and adolescence, supporting a slower time to develop complications with young-onset of diabetes,” the authors of the study wrote.

SOURCE

The study was led by Timothy C. Nielsen, University of Sydney, Sydney, Australia. It was published online in Diabetes Care.

LIMITATIONS

Complications were primarily identified using hospital admission and emergency department records, likely capturing only the more severe cases. The study lacked data on glycemic variability, specific therapies, and lifestyle factors. Additionally, the study relied on Medicare data to capture retinopathy procedures performed outside of hospital settings.

DISCLOSURES

The study received support from a Diabetes Australia Research Trust Grant. One author reported receiving funding from the Financial Markets Foundation for Children and a National Health and Medical Research Council Investigator Grant, and another author reported receiving a National Health and Medical Research Council Practitioner Fellowship. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.