Young age at diabetes diagnosis tied to worse outcomes

Individuals who are diagnosed with type 2 diabetes (T2D) at age ≤40 years have a greater risk of cardiovascular disease (CVD) and mortality than same-aged individuals without T2D or individuals diagnosed with T2D in later life, according to a study from Korea presented at EASD 2022.

Using 2012–2014 data from the Korean National Health Insurance Service, the researchers identified 634,350 patients with newly-diagnosed T2D (mean age 56 years, 60 percent male). They were propensity-score matched (1:2) by age, sex, and prior history of CVD with 1,234,670 random individuals from the general population. A majority of the patients were aged 50–60 years at T2D diagnosis (mean age 56 years).  

The participants were followed up for a median 5.67 years. During this time, heart attack, stroke, or CVD-related death was documented in 40 percent of patients with early-onset T2D (n=172,140) and 23 percent of the control group (n=151,363).

The risk of the outcomes assessed were significantly higher among patients with T2D compared with controls, including all-cause mortality (hazard ratio [HR], 1.940), CVD-related mortality (HR, 1.546), hospitalization for heart failure (HHF; HR, 3.005), coronary heart disease (CHD; HR, 2.684), stroke (HR, 2.405), acute myocardial infarction (MI; HR, 2.868), and 3-point major adverse cardiovascular events (MACE; HR, 2.478; p<0.0001 for all). [EASD 2022, abstract 833]

The risks were particularly elevated among patients who were diagnosed with T2D at age ≤40 years compared with controls. These included the risk for all-cause mortality (adjusted HR [adjHR], 6.08), CVD-related mortality (adjHR, 5.53), HHF (adjHR, 7.19), CHD (adjHR, 5.10), stroke (adjHR, 5.87), MI (adjHR, 8.2), and 3-point MACE (adjHR, 6.94).

The risks for all outcomes attenuated progressively with each increasing decade of age at diagnosis, though they remained significantly higher than that of controls, said the researchers.

For instance, among patients aged ≥91 years at T2D diagnosis, the risk of total mortality, CVD-related mortality, HHF, and CHD were still higher compared with controls (adjHRs, 1.29, 1.32, 2.95, and 3.66, respectively).

“Although T2D is a disease related to ageing, the prevalence of adult early-onset [T2D] has increased globally,” noted lead author Dr Da Hea Seo from the Inha University School of Medicine, Incheon, South Korea. This could be due to the increasing rates of obesity, particularly in young people, she said. Early-onset T2D has been associated with poor metabolic control and the accelerated development of complications, she continued.

“[In our study,] the risks for a range of non-fatal CVD outcomes were even more markedly elevated in those with T2D diagnosed at a younger age, in particular for MI and HHF, where incremental relative risks [were about] seven times higher than matched controls,” said Seo. “Our findings clearly highlight the serious health implications of developing T2D at a young age and the importance of efforts to prevent diabetes in early life,” she added, calling for further research to examine if the results are generalizable to other populations.

“Caring for young people with diabetes, which has traditionally focused on type 1 diabetes, should place more emphasis on T2D … [E]ffective healthcare policies around screening [and] early diagnosis and treatment will help to combat the future rise of CVD in this increasingly common young-onset, high-risk population,” said study co-author Dr Seong Bin Hong, also from the Inha University School of Medicine.

According to Seo, the significantly elevated CV and mortality risks, even among those who were diagnosed at a later age, highlight the need for screening for T2D in all age groups.