An Inverse Relationship Between Age of Type 2 Diabetes Onset and Complication Risk and Mortality: The Impact of Youth-Onset Type 2 Diabetes

Abstract

OBJECTIVEThis study compared the prevalence of complications in 354 patients with T2DM diagnosed between 15 and 30 years of age (T2DM [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] ) with that in a durationmatched cohort of 1,062 patients diagnosed between 40 and 50 years (T2DM [40][41][42][43][44][45][46][47][48][49][50] ). It also examined standardized mortality ratios (SMRs) according to diabetes age of onset in 15,238 patients covering a wider age-of-onset range. RESEARCH DESIGN AND METHODSComplication status was assessed according to a standard protocol and extracted from our electronic database. Survival status was ascertained by data linkage with the Australian National Death Index. SMRs were calculated in comparison with the background Australian population and analyzed according to age of onset. RESULTSAfter matching for duration, despite their younger age, T2DM 15-30 had more severe albuminuria (P = 0.004) and neuropathy scores (P = 0.003). T2DM 15-30 were as commonly affected by metabolic syndrome factors as T2DM 40-50 but less frequently treated for hypertension and dyslipidemia (P < 0.0001). An inverse relationship between age of diabetes onset and SMR was seen, which was the highest for T2DM 15-30 (3.4 [95% CI 2.7-4.2]). SMR plots adjusting for duration show that for those with T2DM 15-30 , SMR is the highest at any chronological age, with a peak SMR of more than 6 in early midlife. In contrast, mortality for older-onset groups approximates that of the background population. CONCLUSIONSThe negative effect of diabetes on morbidity and mortality is greatest for those diagnosed at a young age compared with T2DM of usual onset. These results highlight the growing imperative to direct attention toward young-onset T2DM and for effective interventions to be applied before middle age.Type 2 diabetes is well recognized to be a heterogeneous disorder, and its effect on morbidity and mortality may not be identical within this diagnosis. No longer just a disorder of mature age, there is now a well-recognized trend toward younger people presenting with this disease, particularly for some ethnic groups. Adolescents accounted for less than 4% of incident type 2 diabetes cases in the U.S. 15 years ago, but in a more

Analysis of complicating risk factors of Type 2 Diabetes Mellitus (T2DM)

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Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997–2011

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