Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses

Abstract

Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). Results Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). Conclusions/interpretation Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality.

Association Between Age at Diagnosis of Type 2 Diabetes and Cardiovascular Diseases: A Nationwide, Population-Based, Cohort Study

“…Young-onset type 2 diabetes has been associated with an increased CVD risk in previous epidemiology studies ( 3 , 10 , 11 , 13 , 31 , 32 ). Our study is consistent with some previous studies ( 8 , 13 – 15 ), emphasized that those with earlier-onset type 2 diabetes might be associated with worse macrovascular outcomes than later-onset type 2 diabetes. In the cross-sectional study from the China National HbA1c Surveillance System, patients with early-onset type 2 diabetes had an increased risk of non-fatal CVD than people with late-onset diabetes after further adjustment for diabetes duration ( 8 ).…”

“…A study including 7,844 newly diagnosed diabetes reported that the hazard of macrovascular complication in early-onset type 2 diabetic patients was twice as high in usual-onset diabetes compared with age-matched control subjects ( 14 ). Similarly, a recent meta-analysis including 26 observational studies comprising 1,325,493 individuals confirmed that age at diagnosis of diabetes was inversely associated with risk of macrovascular disease, with each 1-year increase in age at diabetes diagnosis associated with a 3% decreased risk of macrovascular disease (OR 0.97, 95%CI 0.96- 0.98) ( 15 ). However, some studies suggested there was a positive ( 16 , 17 ) or null association ( 9 , 18 ) between age at diagnosis of diabetes and CVD risk.…”

“…Although the impact of age at diagnosis of type 2 diabetes on the risk of cardiovascular disease (CVD) has been investigated in previous studies ( 8 , 9 , 13 – 17 ), the results remain inconclusive. Some studies proposed inverse association between age at diagnosis of diabetes and risk of CVD ( 8 , 14 , 15 ), whereas others suggested positive ( 16 , 17 ) or null association ( 9 , 18 ) in prospective analyses.…”

Microvascular complications and its predictors among type 2 diabetes mellitus patients at Dessie town hospitals, Ethiopia

“…Moreover, being older is a powerful predictor of vascular damages. They also develop premature complications and death as compared to younger age [ 41 ].…”

Association between Metabolic Syndrome Components and Cardiac Autonomic Modulation among Children and Adolescents: A Systematic Review and Meta-Analysis

“…The relationship between CAM or low HRV and compromised cardiovascular health has been comprehensively studied in adults; however, such studies are scarce in adolescents and children. In a recent meta-analysis comprising millions of subjects, Nanayankkara et al [ 15 ] observed that younger rather than older age people with diabetes were associated with a higher risk of mortality and vascular disease. They also proposed that identification and quantification of the increased risk of mortality and vascular disease conferred by a younger age at T2D diagnosis may enable risk stratification of individuals in the early stages of the condition.…”