Inadequate management common in young-onset Type 2 diabetes

By Laura Cowen, medwireNews Reporter

Patients with young-onset Type 2 diabetes have worse metabolic control than those with late-onset disease, but they are less likely to receive organ-protective drugs, show data from the Joint Asia Diabetes Evaluation (JADE) cohort.

These findings “suggest an impending epidemic of young-onset diabetic complications”, write Juliana Chan (The Chinese University of Hong Kong) and study co-authors in The Lancet Diabetes and Endocrinology.

The researchers found that 18% of 41,029 patients with Type 2 diabetes, enrolled from 245 institutions in nine countries across Asia over a 5-year period, were diagnosed with the disease before the age of 40 years. The mean age at diagnosis for these patients was 32.9 years compared with 53.9 years for patients with late-onset diabetes (diagnosed at 40 years or older).

Patients with young-onset diabetes also had longer disease duration than those with late-onset diabetes (median 10 vs 5 years), and were more likely to be men (57 vs 52%), obese (35 vs 26%), have a family history of diabetes (67 vs 53%), use alcohol occasionally or regularly (33 vs 27%) and be a current smoker (17 vs 14%).

In terms of disease control, patients with young-onset diabetes had significantly higher concentrations of glycated haemoglobin (HbA1c) than those with late-onset diabetes (mean 8.32 vs 7.69%) and were significantly less likely to achieve HbA1c concentrations lower than 7% (27 vs 42%), despite being more likely to be receiving insulin (24 vs 15%).

Young-onset Type 2 diabetes was also associated with higher low-density lipoprotein cholesterol levels (2.78 vs 2.74 mmol/L) and a higher prevalence of diabetic retinopathy (20 vs 18%).

However, patients with young-onset disease were less likely than those with late-onset diabetes to receive statins (31 vs 37%), antihypertensives (31 vs 38%) and renin-angiotensin-system inhibitors (25 vs 29%).

“These data are concerning in view of the proven benefits of early control of cardiometabolic risk factors on long-term risk of complications,” say the researchers.

After adjusting for disease duration and other major confounders, Chan and team found that younger age at diagnosis was still significantly and independently associated with poor glycaemic control. And this finding was “consistent across all countries despite the wide range of clinical practices, health-care systems, and coverage for insurance and medication”, they note.

In an accompanying editorial, Soon Song, from Northern General Hospital in Sheffield, UK, says that the study findings have several important clinical ramifications. Principally, “they emphasise that suboptimum treatment of risk factors is widespread, affecting individuals with young-onset disease across different age groups”.

He concludes that, if the future of these young patients is going to improve, immediate changes are required at all levels “from the restructuring of health-care systems to the changing of clinicians’ mind-set”.

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