Clinical Characteristics, Glycemic Control, and Microvascular Complications Compared Between Young-Onset Type 1 and Type 2 Diabetes Patients at Siriraj Hospital – A Tertiary Referral Center

Figures & data

Table 1 Sociodemographic and Clinical Characteristics Compared Between Young-Onset Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) Patients

	T1DM (N=301)	T2DM (N=95)	p-value
Clinical characteristic at diagnosis
Age, years	9.7±5.4	16.9±6.4	< 0.001*
Age, n (%)			< 0.001*
Age 0 to <10 years	180 (59.8)	9 (9.5)
Age 10 to <20 years	102 (33.9)	56 (58.9)
Age 20 to 30 years	19 (6.3)	30 (31.6)
Acanthosis nigricans, n (%)	7 (3.3) (n=210)	53 (82.8) (n=64)	< 0.001*
BMI, kg/m^2	17.2±4.1 (n=113)	30.8±7.9 (n=62)	< 0.001*
Diabetes ketoacidosis, n (%)	199 (66.1)	13 (13.7)	< 0.001*
Age 0 to <10 years	133 (73.9)	–	< 0.001*
Age 10 to <20 years	60 (58.8)	12 (21.4)	< 0.001*
Age 20 to 30 years	6 (31.6)	1 (3.3)	0.005*
Random plasma glucose (mg/dL)	456±154 (n=32)	260±107 (n=10)	0.001*
Random plasma glucose (mmol/L)	25.3±8.5	14.4±6.0
Fasting plasma glucose (mg/dL)	291±70 (n=27)	246±142 (n=41)	0.132
Fasting plasma glucose (mmol/L)	16.2±3.9	13.7±7.9
HbA1c, %	12.8±2.6 (n=57)	10.9±3.1 (n=30)	0.002*
Age 0 to <10 years	12.2±2.2 (n=36)	14.1±3.3 (n=2)	0.248
Age 10 to <20 years	14.0±2.9 (n=19)	11.2±3.3 (n=19)	0.008*
Age 20 to 30 years	13.2±4.7 (n=2)	9.4±2.1 (n=9)	0.461
Clinical characteristic at registry
Age, years	18.6±9.5	23.4±8.5	< 0.001*
Duration of DM, years	6.7 (3.5, 12.1)	5.2 (1.6, 9.4)	0.005*
Female gender, n (%)	186 (61.8)	54 (56.8)	0.389
Health insurance schemes, n (%)			< 0.001*
Universal health coverage scheme	212 (70.4)	52 (54.7)
Civil servant medical benefit scheme	43 (14.3)	8 (8.4)
Social security scheme	16 (5.3)	14 (14.7)
Self-payment	27 (9)	21 (22.1)
Others	3 (1)	–
Educational status, n (%)			< 0.001*
Studying	224 (74.4)	41 (43.2)
Graduate	50 (16.6)	41 (43.2)
Primary school	2 (4.1)	7 (17.1)
Secondary school	10 (20.4)	15 (36.6)
Bachelor degree	30 (61.2)	19 (46.3)
Master degree	7 (14.3)	-
Family history of DM, n (%)	131 (44.1)	76 (80.0)	< 0.001*
Comorbidity, n (%)
Obesity	60 (19.9)	79 (83.2)	< 0.001*
Dyslipidemia	50 (16.6)	48 (50.5)	< 0.001*
Hypertension	17 (5.6)	35 (36.8)	< 0.001*

Note: Data were presented as mean ± SD and median (IQR) as appropriate. *Significant at p-value < 0.05.

Figure 1 Type of young-onset diabetes compared between genders among all included patients and stratified by age group.

Figure 2 Pancreatic antibody results in 238 patients with young-onset type 1 diabetes mellitus. Each patient underwent testing for 1, 2, or 3 different pancreatic antibodies according to the physician’s discretion.

Figure 3 Glycemic control compared between young-onset type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients. (A) Glycemic control among all T1DM and stratified by age group. (B) Glycemic control among all T2DM and stratified by age group. (C) Mean most recent glycated hemoglobin (HbA1c) level within 6 months compared between T1DM and T2DM and stratified by age group. (D) Mean most recent HbA1c level among T1DM patients stratified by frequency of self -monitoring of blood glucose (SMBG).

Table 2 Glycemic Control and Management at the Time of Registration in the Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN) Compared Between Young-Onset Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) Patients

	T1DM (n=301)	T2DM (n=95)	p-value
Latest HbA1c within 6 months, %	8.3±1.8	8.1±2.2	0.303
Latest HbA1c Subgroup by age at registry, %
0 to <10 years	7.8±1.1	6.7	0.323
10 to <20 years	8.7±1.9	7.9±2.4	0.019*
≥ 20 years	7.9±1.6	8.2±2.1	0.300
Diabetic ketoacidosis in 12 months, n (%)	21 (6.9)	2 (2.2)	0.079
Severe hypoglycemia in 12 months, n (%)	10 (3.4)	–
Frequency of SMBG (times/day)	3.0±1.1	1.0±1.3	< 0.001*
≤ 1 n (%)	44 (14.6)	68 (71.5)	< 0.001*
2 n (%)	51 (16.9)	12 (12.6)
3 n (%)	77 (25.6)	6 (6.3)
≥ 4 n (%)	121 (40.2)	5 (5.3)
Anti-hyperglycemic agent (AHA), n (%)			< 0.001*
Insulin only	285 (94.7)	10 (10.5)
Insulin and oral AHA	16 (5.3)	41 (43.2)
Oral AHA	–	37 (38.9)
Oral AHA and GLP-1RA	–	4 (4.2)
Insulin and GLP-1RA	–	1 (1.1)
Insulin regimen, n (%)			< 0.001*
Conventional regimen	67 (22.3)	29 (55.8)
Basal insulin	–	14 (26.9)
Basal bolus insulin	230 (76.4)	8 (15.4)
Continuous subcutaneous insulin infusion	4 (1.3)	–
Oral anti-hyperglycemia agent, n (%)			< 0.001*
Metformin	16 (5.3)	77 (81.1)
Sulfonylurea	–	27 (28.4)
Thiazolidinedione	–	14 (14.7)
DPP4 inhibitor	–	4 (4.2)

Note: Data were presented as mean ± SD and median (IQR) as appropriate. *Significant at p-value < 0.05.

Abbreviations: SMBG, self-monitoring blood glucose. GLP-1RA, glucagon-like peptide-1 receptor agonist.

Table 3 Diabetic Microvascular Complications at the Time of Registration in the Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN) Compared Between Young-Onset Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) Patients

Diabetes complication	T1DM (n=301)	T2DM (n=95)	p-value
Diabetic retinopathy screening rate, n (%)	245 (81.4)	89 (93.7)	0.004*
Mild to mod DR, n (%)	17 (6.9)	4 (4.5)	0.428
Severe NPDR/ PDR, n (%)	9 (3.7)	4 (4.5)	0.717
Vitreous hemorrhage/ macular edema, n (%)	2 (0.8)	–
DM duration to DR, years	19.1 (13.9,24.6)	16.0 (13.1,19.6)	0.270
Latest HbA1c, %	7.9±1.1	8.9±2.1	0.266
Diabetic nephropathy screening rate, n (%)	247 (82.1)	83 (87.4)	0.226
Microalbuminuria, n (%)	25 (10.1)	33 (40.2)	< 0.001*
DM duration to microalbuminuria, years	13.8 (9.2,20.7)	5.7 (4.0,9.4)	< 0.001*
Latest HbA1c, %	8.8±2.3	8.6±1.9	0.689
Diabetic neuropathy, n (%)	119 (39.5)	55 (57.9)	0.002*
Diabetes neuropathy, n (%)	4 (3.4)	3 (5.5)	0.514
Latest HbA1c, %	9.4±3.8	8.2±0.5	0.614

Note: Data were presented as mean ± SD and median (IQR) as appropriate. *Significant at p-value < 0.05.

Table 4 Univariate Analysis of Factors Associated with Diabetes Retinopathy and Diabetes Nephropathy Compared Between Young-Onset Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) Patients

Diabetes retinopathy (DR)
	T1DM			T2DM
	No DR (n= 219)	DR (n=26)	p-value	No DR (n= 80)	DR (n=8)	p-value
Age at diagnosis, years	9.5±5.1	14.0±6.7	0.002*	16.8±6.4	18.5±7.8	0.469
Duration of DM, years	7.7 (4.5,11.7)	19.1 (13.9,24.6)	<0.001*	4.8 (1.3,8.3)	16.0 (13.1,19.6)	<0.001*
Latest HbA1c, %	8.4±1.8	7.9±1.1	0.050	7.9±2.2	8.9±2.1	0.290
BMI, kg/m^2	22.1±4.1	22.9±4.7	0.350	31.6±	28.3±9.2	0.236
Female gender, n (%)	132 (60.3)	18 (69.2)	0.376	47 (58.8)	6 (75)	0.469
Dyslipidemia, n (%)	36 (16.4)	11 (42.3)	0.003*	39 (48.8)	6 (75)	0.267
Hypertension, n (%)	8 (3.7)	9 (34.6)	<0.001*	28 (35)	5 (62.5)	0.145
Diabetes nephropathy (DN)
	T1DM			T2DM
	No DN (n= 222)	DN (n=25)	p-value	No DN (n= 49)	DN (n=33)	p-value
Age at diagnosis, years	10.0±5.1	12.2±6.2	0.063	16.4±6.1	17.8±6.4	0.314
Latest HbA1c, %	8.3±1.6	8.8±2.3	0.328	7.7±2.4	8.6±1.9	0.087
Duration of DM, years	7.9 (4.6,12.5)	13.8 (9.2,20.7)	<0.001*	4.3 (0.9,8.3)	5.7 (4.0,9.4)	0.143
BMI, kg/m^2	22.1±4.0	23.7±3.9	0.051	30.2±6.9	31.9±6.9	0.298
Female gender, n (%)	133 (59.9)	18 (72.0)	0.240	23 (46.9)	21 (63.6)	0.137
Dyslipidemia, n (%)	40 (18.0)	9 (36.0)	0.059	20 (40.8)	24 (72.7)	0.004*
Hypertension, n (%)	9 (4.1)	8 (32.0)	<0.001*	14 (28.6)	18 (54.5)	0.018*

Note: Data were presented as mean ± SD and median (IQR) as appropriate. *Significant at p-value < 0.05.