{"id":{"repo_id":"auckland-ms","oai_identifier":"oai:researchspace.auckland.ac.nz:2292/66003"},"canonical_url":"https://search.dev.ndltd.org/etd/auckland-ms/oai:researchspace.auckland.ac.nz:2292/66003","repository":{"repo_id":"auckland-ms","name":"University of Auckland","base_url":"https://researchspace.auckland.ac.nz/server/oai/request"},"display":{"title":"Young-Onset Type 2 Diabetes in the Auckland Region - Clinical Outcomes and Healthcare Service Use in Comparison to Type 1 Diabetes","abstract":"Objectives: Investigate clinical outcomes and healthcare service use in young-onset (15-30 years-of-age) type 2 diabetes (T2D) in comparison to type 1 diabetes (T1D). Methods: Retrospective study including 731 people with T1D and 1350 with T2D, analysing complications, risk-factors, medication dispensing, primary-care visits, diabetes clinic attendance, hospital admissions. A national index of deprivation (NZDep) was used to assess the impact of socioeconomic deprivation. Results: The median duration of known diabetes was 8 years for both groups. A greater proportion of the T2D group lived in the most deprived NZDep deciles (9&10) (58% vs 28% of T1D, p<0.001). 46% of people with T2D had a urine albumin:creatinine (ACR) >3.5 mg/mmol in the year of diagnosis, increasing to 61% 8 years later. Logistic regression with established risk factors (including BMI) showed: T2D (OR 2.72, 95% CI 1.95-3.80), NZDep (OR 1.07, 95% CI 1.06-1.12), Māori (OR 2.64, 95% CI 1.79-3.89), Pasifika (OR 2.64, 95% CI 1.79-3.88), Indian (OR 2.50, 95% CI 1.52 to 4.52, p=0.0003) and Asian ethnicities (OR 1.83, 95% CI 1.08-3.10) were more likely to have a higher ACR. NZDep (OR 1.12, 95% CI 1.07-1.77), Pasifika (OR 2.62, 95% CI 1.81-3.80, p<0.0001), Māori (OR 2.22, 95% CI 1.55-3.19, p<0.0001), and Asian ethnicities (OR 0.61, CI 0.38-0.95) influenced the likelihood of having a HbA1c >64 mmol/mol. The median 5-year CVD risk was significantly higher for T2D (8.1% vs 4.9%, p<0.001). Adjusted for HbA1c, and NZDep, Pasifika (OR 2.79, 95% CI 1.43-5.44) and Māori (OR 2.05, 95% CI 1.03-4.09) were more likely to have a delayed (>1 year after diagnosis) referral to diabetes services. The median number of appointments offered over 2 years was greater for T1D (2.0 (IQR 0, 7) vs 0 (IQR 0, 2), p<0.001); non-attendance increased with NZDep for T2D (p=0.016). The proportion with hospital admissions was similar in both groups, with higher rates of admission with increasing NZDep (T1D p<0.001, T2D p=0.015). Over a 6-month period, 31% of those with an HbA1c >100mmol/mol were not dispensed any hypoglycaemic medication, 27% of those with cerebrovascular/cardiovascular/peripheral vascular disease were not dispensed a statin, and 30% with ACR >30mg/mmol were not dispensed an ACE inhibitor/angiotensin receptor blocker. Conclusions: A comprehensive strategy is needed to better manage young-onset T2D addressing socioeconomic disparities.","abstract_html":"Objectives: Investigate clinical outcomes and healthcare service use in young-onset (15-30 years-of-age) type 2 diabetes (T2D) in comparison to type 1 diabetes (T1D). Methods: Retrospective study including 731 people with T1D and 1350 with T2D, analysing complications, risk-factors, medication dispensing, primary-care visits, diabetes clinic attendance, hospital admissions. A national index of deprivation (NZDep) was used to assess the impact of socioeconomic deprivation. Results: The median duration of known diabetes was 8 years for both groups. A greater proportion of the T2D group lived in the most deprived NZDep deciles (9&amp;10) (58% vs 28% of T1D, p&lt;0.001). 46% of people with T2D had a urine albumin:creatinine (ACR) &gt;3.5 mg/mmol in the year of diagnosis, increasing to 61% 8 years later. Logistic regression with established risk factors (including BMI) showed: T2D (OR 2.72, 95% CI 1.95-3.80), NZDep (OR 1.07, 95% CI 1.06-1.12), Māori (OR 2.64, 95% CI 1.79-3.89), Pasifika (OR 2.64, 95% CI 1.79-3.88), Indian (OR 2.50, 95% CI 1.52 to 4.52, p=0.0003) and Asian ethnicities (OR 1.83, 95% CI 1.08-3.10) were more likely to have a higher ACR. NZDep (OR 1.12, 95% CI 1.07-1.77), Pasifika (OR 2.62, 95% CI 1.81-3.80, p&lt;0.0001), Māori (OR 2.22, 95% CI 1.55-3.19, p&lt;0.0001), and Asian ethnicities (OR 0.61, CI 0.38-0.95) influenced the likelihood of having a HbA1c &gt;64 mmol/mol. The median 5-year CVD risk was significantly higher for T2D (8.1% vs 4.9%, p&lt;0.001). Adjusted for HbA1c, and NZDep, Pasifika (OR 2.79, 95% CI 1.43-5.44) and Māori (OR 2.05, 95% CI 1.03-4.09) were more likely to have a delayed (&gt;1 year after diagnosis) referral to diabetes services. The median number of appointments offered over 2 years was greater for T1D (2.0 (IQR 0, 7) vs 0 (IQR 0, 2), p&lt;0.001); non-attendance increased with NZDep for T2D (p=0.016). The proportion with hospital admissions was similar in both groups, with higher rates of admission with increasing NZDep (T1D p&lt;0.001, T2D p=0.015). Over a 6-month period, 31% of those with an HbA1c &gt;100mmol/mol were not dispensed any hypoglycaemic medication, 27% of those with cerebrovascular/cardiovascular/peripheral vascular disease were not dispensed a statin, and 30% with ACR &gt;30mg/mmol were not dispensed an ACE inhibitor/angiotensin receptor blocker. Conclusions: A comprehensive strategy is needed to better manage young-onset T2D addressing socioeconomic disparities.","abstract_has_math":false,"creators":["Wijayaratna, Sasini"],"institution":"ResearchSpace@Auckland","degree_name":"PhD","degree_level":"Doctoral","degree_discipline":"Medicine","degree_department":null,"school":null,"contributors":[],"advisors":["Bagg, Warwick","Lee, Arier"],"committee_chairs":[],"committee_members":[],"year":2023,"date_issued":"2023","date_published":"2023","updated_at":"2026-07-24T01:06:29Z","subjects":[],"languages":[],"rights":["Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated."],"rights_urls":["https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm"],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/2292/66003","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Bagg, Warwick","Lee, Arier"]},{"key":"dc:creator","label":"Author","values":["Wijayaratna, Sasini"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2023-09-27T19:49:07Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2023-09-27T19:49:07Z"]},{"key":"dc:date.issued","label":"Date","values":["2023"]},{"key":"dc:publisher","label":"Institution","values":["ResearchSpace@Auckland"]},{"key":"dc:relation.isreferencedby","label":"Dc Relation Isreferencedby","values":["UoA"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Medicine"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Doctoral"]},{"key":"thesis:degree_name","label":"Degree Name","values":["PhD"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["The University of Auckland"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated."]},{"key":"dc:rights.uri","label":"Rights URI","values":["https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/2292/66003"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Objectives: Investigate clinical outcomes and healthcare service use in young-onset (15-30 years-of-age) type 2 diabetes (T2D) in comparison to type 1 diabetes (T1D). Methods: Retrospective study including 731 people with T1D and 1350 with T2D, analysing complications, risk-factors, medication dispensing, primary-care visits, diabetes clinic attendance, hospital admissions. A national index of deprivation (NZDep) was used to assess the impact of socioeconomic deprivation. Results: The median duration of known diabetes was 8 years for both groups. A greater proportion of the T2D group lived in the most deprived NZDep deciles (9&10) (58% vs 28% of T1D, p<0.001). 46% of people with T2D had a urine albumin:creatinine (ACR) >3.5 mg/mmol in the year of diagnosis, increasing to 61% 8 years later. Logistic regression with established risk factors (including BMI) showed: T2D (OR 2.72, 95% CI 1.95-3.80), NZDep (OR 1.07, 95% CI 1.06-1.12), Māori (OR 2.64, 95% CI 1.79-3.89), Pasifika (OR 2.64, 95% CI 1.79-3.88), Indian (OR 2.50, 95% CI 1.52 to 4.52, p=0.0003) and Asian ethnicities (OR 1.83, 95% CI 1.08-3.10) were more likely to have a higher ACR. NZDep (OR 1.12, 95% CI 1.07-1.77), Pasifika (OR 2.62, 95% CI 1.81-3.80, p<0.0001), Māori (OR 2.22, 95% CI 1.55-3.19, p<0.0001), and Asian ethnicities (OR 0.61, CI 0.38-0.95) influenced the likelihood of having a HbA1c >64 mmol/mol. The median 5-year CVD risk was significantly higher for T2D (8.1% vs 4.9%, p<0.001). Adjusted for HbA1c, and NZDep, Pasifika (OR 2.79, 95% CI 1.43-5.44) and Māori (OR 2.05, 95% CI 1.03-4.09) were more likely to have a delayed (>1 year after diagnosis) referral to diabetes services. The median number of appointments offered over 2 years was greater for T1D (2.0 (IQR 0, 7) vs 0 (IQR 0, 2), p<0.001); non-attendance increased with NZDep for T2D (p=0.016). The proportion with hospital admissions was similar in both groups, with higher rates of admission with increasing NZDep (T1D p<0.001, T2D p=0.015). Over a 6-month period, 31% of those with an HbA1c >100mmol/mol were not dispensed any hypoglycaemic medication, 27% of those with cerebrovascular/cardiovascular/peripheral vascular disease were not dispensed a statin, and 30% with ACR >30mg/mmol were not dispensed an ACE inhibitor/angiotensin receptor blocker. Conclusions: A comprehensive strategy is needed to better manage young-onset T2D addressing socioeconomic disparities."]},{"key":"dc:title","label":"Title","values":["Young-Onset Type 2 Diabetes in the Auckland Region - Clinical Outcomes and Healthcare Service Use in Comparison to Type 1 Diabetes"]}]}],"canonical_facts":{"dc:contributor.advisor":["Bagg, Warwick","Lee, Arier"],"dc:creator":["Wijayaratna, Sasini"],"dc:date.accessioned":["2023-09-27T19:49:07Z"],"dc:date.available":["2023-09-27T19:49:07Z"],"dc:date.issued":["2023"],"dc:description.abstract":["Objectives: Investigate clinical outcomes and healthcare service use in young-onset (15-30 years-of-age) type 2 diabetes (T2D) in comparison to type 1 diabetes (T1D). Methods: Retrospective study including 731 people with T1D and 1350 with T2D, analysing complications, risk-factors, medication dispensing, primary-care visits, diabetes clinic attendance, hospital admissions. A national index of deprivation (NZDep) was used to assess the impact of socioeconomic deprivation. Results: The median duration of known diabetes was 8 years for both groups. A greater proportion of the T2D group lived in the most deprived NZDep deciles (9&10) (58% vs 28% of T1D, p<0.001). 46% of people with T2D had a urine albumin:creatinine (ACR) >3.5 mg/mmol in the year of diagnosis, increasing to 61% 8 years later. Logistic regression with established risk factors (including BMI) showed: T2D (OR 2.72, 95% CI 1.95-3.80), NZDep (OR 1.07, 95% CI 1.06-1.12), Māori (OR 2.64, 95% CI 1.79-3.89), Pasifika (OR 2.64, 95% CI 1.79-3.88), Indian (OR 2.50, 95% CI 1.52 to 4.52, p=0.0003) and Asian ethnicities (OR 1.83, 95% CI 1.08-3.10) were more likely to have a higher ACR. NZDep (OR 1.12, 95% CI 1.07-1.77), Pasifika (OR 2.62, 95% CI 1.81-3.80, p<0.0001), Māori (OR 2.22, 95% CI 1.55-3.19, p<0.0001), and Asian ethnicities (OR 0.61, CI 0.38-0.95) influenced the likelihood of having a HbA1c >64 mmol/mol. The median 5-year CVD risk was significantly higher for T2D (8.1% vs 4.9%, p<0.001). Adjusted for HbA1c, and NZDep, Pasifika (OR 2.79, 95% CI 1.43-5.44) and Māori (OR 2.05, 95% CI 1.03-4.09) were more likely to have a delayed (>1 year after diagnosis) referral to diabetes services. The median number of appointments offered over 2 years was greater for T1D (2.0 (IQR 0, 7) vs 0 (IQR 0, 2), p<0.001); non-attendance increased with NZDep for T2D (p=0.016). The proportion with hospital admissions was similar in both groups, with higher rates of admission with increasing NZDep (T1D p<0.001, T2D p=0.015). Over a 6-month period, 31% of those with an HbA1c >100mmol/mol were not dispensed any hypoglycaemic medication, 27% of those with cerebrovascular/cardiovascular/peripheral vascular disease were not dispensed a statin, and 30% with ACR >30mg/mmol were not dispensed an ACE inhibitor/angiotensin receptor blocker. Conclusions: A comprehensive strategy is needed to better manage young-onset T2D addressing socioeconomic disparities."],"dc:identifier.uri":["https://hdl.handle.net/2292/66003"],"dc:publisher":["ResearchSpace@Auckland"],"dc:relation.isreferencedby":["UoA"],"dc:rights":["Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated."],"dc:rights.uri":["https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm"],"dc:title":["Young-Onset Type 2 Diabetes in the Auckland Region - Clinical Outcomes and Healthcare Service Use in Comparison to Type 1 Diabetes"],"dc:type":["Thesis"],"thesis:degree_discipline":["Medicine"],"thesis:degree_level":["Doctoral"],"thesis:degree_name":["PhD"],"thesis:institution_name":["The University of Auckland"]},"updated_at":"2026-07-24T01:06:29Z"}