Youth-onset T2D patients at high risk of CVD, ESKD

The risks of cardiovascular disease (CVD) and end-stage kidney disease (ESKD) are elevated twofold in individuals with youth-onset type 2 diabetes (T2D), which is partly caused by the greater burden of obesity and other metabolic risk factors in this population, relative to those with type 1 diabetes (T1D), according to a Hong Kong study.

Lead researcher Yingnan Fan and colleagues presented the results of their study at the 82nd Scientific Sessions of the America Diabetes Association (ADA 2022) held in New Orleans, Los Angeles, US.

The researchers noted the lack of studies reporting the incidence rates of late-stage complications in people with youth-onset T2D. To address this, they compared the clinical characteristics and incidence of CVD, ESKD, and mortality in a cohort of Chinese youth with T2D (n=1,221) and T1D (n=641) in a retrospective analysis.

Patients were diagnosed at age <20 years and underwent metabolic and complication assessment at the Hong Kong Hospital Authority between 2000 and 2019. They were followed for incident CVD, ESKD, and all-cause death until 2019. The hazards of complications in T2D vs T1D were determined using Cox regression models.

Compared with patients with T1D, those with youth-onset T2D were older at diagnosis (14‒18 vs 8‒16 years; p<0.01) but had similar diabetes duration (2‒15 vs 2‒13 years; p=0.32) at baseline. The T2D group also had a higher frequency of obesity (71.3 percent vs 14.6 percent), hypertension (48.3 percent vs 21.0 percent), dyslipidaemia (58.8 percent vs 24.1 percent), and albuminuria (29.8 percent vs 11.2 percent; p<0.01). [ADA 2022, abstract 984-P]

Incidence rates per 1,000 person-years for T2D patients compared with those with T1D over follow-up of 6.7‒7.8 years were 5.3 (95 percent confidence interval [CI], 3.9‒7.0) vs 1.4 (95 percent CI, 0.6‒2.9) for CVD, 8.1 (95 percent CI, 6.4‒10.1) vs 2.4 (95 percent CI, 1.3‒4.2) for ESKD, and 6.9 (95 percent CI, 5.4‒8.7) vs 2.6 (95 percent CI, 1.4‒4.4) for death, respectively (p<0.01).

Compared to T1D patients, those in the T2D cohort had higher risks of CVD (hazard ratio [HR], 2.6, 95 percent CI, 1.1‒6.2) and ESKD (HR, 2.4, 95 percent CI, 1.2‒4.5), but not mortality (HR, 1.6, 95 percent CI, 0.8‒2.9), adjusted for age at diagnosis, duration of diabetes, and sex.

Of note, the increased risk for ESKD, but not CVD, persisted after further adjustments for glycaemic control, metabolic control, and smoking.

Diabetes-related complications

In a 2020 study by Hongjiang Wu and colleagues, who used the Hong Kong Diabetes Surveillance Database, event rates of diabetes-related complications dropped substantially with no evidence of increase or stabilization up to 2016. [Cardiovasc Diabetol 2020;19:60]

“Improvements in outcome were observed for all age subgroups but not in young people with diabetes, calling for urgent action to improve quality of care to prevent complications in young people at risk,” the authors said.

“Given the increasing life expectancy of people with diabetes and the vulnerability of older individuals to CVDs, healthcare resources should be appropriately prioritized to support management of these complications to reduce disability and maximize quality of life,” they added.