OBJECTIVE -To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.RESEARCH DESIGN AND METHODS -We performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged Ͻ18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoscopic retinal photography; albumin excretion rate from three consecutive, timed, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA 1c (A1C) and lipids were measured in all patients and C-peptide in patients with type 2 diabetes.RESULTS -In patients with type 1 versus type 2 diabetes, median (interquartile range) age was 15.7 years (13.9 -17.0) and 15.3 years (13.6 -16.4), respectively (P ϭ 0.2), whereas median diabetes duration was 6.8 years (4.7-9.6) and 1.3 years (0.6 -3.1), respectively (P Ͻ 0.0001). Retinopathy was significantly more common in patients with type 1 diabetes (20 vs. 4%, P ϭ 0.04), while microalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes). In multivariate analyses, microalbuminuria was significantly associated with older age (odds ratio 1.3 [95% CI 1.2-1.5], P Ͻ 0.001) and systolic hypertension (3.63 [2.0 -6.3], P Ͻ 0.001) in type 1 diabetes, while only higher A1C (1.7 [1.3-2.9], P ϭ 0.002) was significant in patients with type 2 diabetes.CONCLUSIONS -Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type 1 diabetes, despite shorter diabetes duration and lower A1C. The results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes. Diabetes Care

The management of type 2 diabetes in youth from the Western Pacific Region varies widely. Hypertension and microalbuminuria were frequent, but not commonly treated. Further investigation into the natural history and risk factors for complications in youth with type 2 diabetes is required to assist in developing evidence based management guidelines.