Young onset age heightens Type 2 diabetes complication risks

By Eleanor McDermid, Senior medwireNews Reporter

Patients who develop Type 2 diabetes before the age of 40 years have higher complication risks at any given age than those who develop it later in life, research shows.

The study used data from the Hong Kong Diabetes Registry, including 2066 patients diagnosed with Type 2 diabetes when younger than 40 years and 7440 patients who were older at onset. Patients in the two groups were aged an average of 41.3 and 61.9 years, respectively, and were followed-up for a median of 9.2 and 6.4 years.

“Despite being younger by 20 years, the young-onset group had similar or worse risk profiles than the late-onset group”, report study author Andrea Luk (The Prince of Wales Hospital, Hong Kong, China) and colleagues in The American Journal of Medicine.

The differences in risk profiles between patients with young-onset and later-onset diabetes persisted after accounting for age, so at any given age the younger patients had a higher risk of cardiovascular disease and chronic kidney disease (CKD).

For example, at age 40–44 years, the young-onset group had a cardiovascular disease incidence of 7.0 per 1000 person–years, compared with 3.6 per 1000 person–years in the later-onset group. The corresponding rates at age 55–59 years were 34.2 and 15.7 per 1000 person–years. Overall, a young age at diabetes onset was associated with significant 48% and 35% increases in the risk of cardiovascular disease and CKD, respectively, after accounting for age and gender.

However, this association disappeared after accounting for disease duration, “indicating that the high risk of cardiovascular–renal outcome in this young group was largely explained by the long disease duration”, say the researchers.

Given the longer disease duration at any age, tight glycaemic control in patients with young-onset diabetes is vital, they note. However, patients in this group had significantly higher levels of glycated haemoglobin, at 7.8% versus 7.6%, and fasting plasma glucose, at 9.0 versus 8.5 mmol/L than patients in the later-onset group.

Despite this, young-onset patients were significantly less likely to be taking oral antidiabetic drugs (56.1 vs 69.2%), although they were more often using insulin (19.5 vs 16.4%).

“Our results indicated suboptimal medical attention given to younger patients, in part due to the absence of clinical guidelines targeted to this age group and possibly the misconception of low risks of life-threatening complications in these patients”, say Luk et al.

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