People diagnosed with type 2 diabetes under the age of 40 were more likely to have developed or died from cardiovascular disease (CVD) than those of similar age without the disease, according to the study.
Researchers also found that higher excess risk for most outcomes were numerically greater in younger women with type 2 diabetes than men.
The study, in Circulation , the journal of the American Heart Association, also found that mortality risk, regardless of cause, for people diagnosed with type 2 diabetes at age 80 or older significantly decreased, and was the same as those of people of similar age without diabetes.
Losing a Decade of Life Expectancy
Lead author, Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said that people who developed type 2 diabetes during adolescence or in their 20s were "likely to lose more than around about a decade or even potentially more off life expectancy", whereas for those developing diabetes in their 80s or later "it doesn't have much of an impact at all".
The study authors said their findings amplified support for preventing or delaying the onset of type 2 diabetes in younger individuals.
"At the moment, if people develop type 2 under the age of 30, we're not that aggressive with risk factor management, just because they're young and we think they should be ok," Prof Sattar told Medscape News UK. "But actually I think we need to re-look at that, and in some ways we may need to be more aggressive in those who develop type 2 under 40."
He said that type 2 diabetes was becoming more common in younger age groups. "Nowadays lots of clinics around the UK are seeing more and more people well under the age of 40 – some in their 30s, some in their 20s, and some in their adolescence – and even children.
"And they're the hardest people to manage because they tend to be the most obese and they tend to also have the fastest rise in sugar levels over time."
The researchers used data from the Swedish National Diabetes Registry to follow 318,083 people with type 2 diabetes and 1,575,108 people in a control group who were matched for age, sex and county.
This data were gathered from 1998 to 2013 for heart disease-related conditions, and information on deaths resulting from CVD or any other cause was followed from 1998 to 2014.
During a median follow-up of 2.52 years, researchers compared results to control participants of similar age without type 2 diabetes and found that:
- Participants diagnosed with type 2 diabetes before the age of 40 had the greatest excess risk for total mortality, stroke, heart attack, heart failure or atrial fibrillation
- Women generally carried higher excess cardiovascular disease and mortality risks than men in most categories
- Excess risks for cardiovascular disease and life years lost declined steadily with the age of diagnosis of type 2 diabetes
Prof Sattar said that the findings also had implications for the relative risks from late onset type 2 diabetes for men and women. "It kind of narrows the gap. It doesn't mean that women with diabetes are at higher risk than men, but it's pretty close," he said.
The authors acknowledged that their study followed a majority white European population and left open the need to examine the role of cardiovascular disease in non-white populations with type 2 diabetes.
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Age at Diagnosis of Type 2 Diabetes Mellitus and Associations With Cardiovascular and Mortality Risks Findings From the Swedish National Diabetes Registry, Sattar et al, Circulation.
Publication April 2019
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Age at Diagnosis of Type 2 Diabetes Mellitus and Associations With Cardiovascular and Mortality Risks Findings From the Swedish National Diabetes Registry
Findings From the Swedish National Diabetes Registry
Risk of cardiovascular disease (CVD) and mortality for patients with versus without type 2 diabetes mellitus (T2DM) appears to vary by the age at T2DM diagnosis, but few population studies have analyzed mortality and CVD outcomes associations across the full age range.
With use of the Swedish National Diabetes Registry, everyone with T2DM registered in the Registry between 1998 and 2012 was included. Controls were randomly selected from the general population matched for age, sex, and county. The analysis cohort comprised 318 083 patients with T2DM matched with just <1.6 million controls. Participants were followed from 1998 to 2013 for CVD outcomes and to 2014 for mortality. Outcomes of interest were total mortality, cardiovascular mortality, noncardiovascular mortality, coronary heart disease, acute myocardial infarction, stroke, heart failure, and atrial brillation. We also examined life expectancy by age at diagnosis. We conducted the primary analyses using Cox proportional hazards models in those with no previous CVD and repeated the work in the entire cohort.
Over a median follow-up period of 5.63 years, patients with T2DM diagnosed at ≤40 years had the highest excess risk for most outcomes relative to controls with adjusted hazard ratio (95% CI) of 2.05 (1.81–2.33) for total mortality, 2.72 (2.13–3.48) for cardiovascular- related mortality, 1.95 (1.68–2.25) for noncardiovascular mortality, 4.77 (3.86–5.89) for heart failure, and 4.33 (3.82–4.91) for coronary heart disease. All risks attenuated progressively with each increasing decade at diagnostic age; by the time T2DM was diagnosed at >80 years, the adjusted hazard ratios for CVD and non-CVD mortality were <1, with excess risks for other CVD outcomes substantially attenuated. Moreover, survival in those diagnosed beyond 80 was the same as controls, whereas it was more than a decade less when T2DM was diagnosed in adolescence. Finally, hazard ratios for most outcomes were numerically greater in younger women with T2DM.
Age at diagnosis of T2DM is prognostically important
for survival and cardiovascular risks, with implications for determining the timing and intensity of risk factor interventions for clinical decision making and for guideline-directed care. These observations amplify support for preventing/delaying T2DM onset in younger individuals.
From the article
Clinical Perspective What Is New?
- This study examined life expectancy and excess risk of cardiovascular disease and death in people with type 2 diabetes mellitus (T2DM) across a range of ages, in comparison with age-, sex-, and county- matched controls.
- All risks were highest in the patients with diagnosis at a younger age, and risks were attenuated rapidly with increasing age at onset of T2DM.
- Developing T2DM after 80 years of age was not associated with impaired survival.
- The most pronounced excess risks were noted in women with early-onset T2DM.
- What Are the Clinical Implications?
- Treatment target recommendations with regard to the risk factor control may need to be more aggressive in people developing diabetes mellitus at younger ages.
- Many elderly patients with newly diagnosed T2DM but without cardiovascular disease may not require aggressive management of their diabetes mellitus, so that reassessment of treatment goals in elderly patients might be useful.
- Diabetes-screening needs for elderly individuals (>80 years) should also be reevaluated.