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Age at type 2 diabetes diagnosis may impact survival, CVD outcomes
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The age at diagnosis of type 2 diabetes in patients may be important for determining survival and CV outcomes, according to findings published in Circulation.
Naveed Sattar, MD, PhD, and colleagues sought to determine life expectancy by age of diagnosis.
“Our study shows the differences in excess diabetes risk are tied to how old the person is when they are diagnosed with type 2 diabetes,” Sattar, professor of metabolic medicine at the University of Glasgow in Scotland, said in a press release.
The researchers analyzed data from 318,083 patients with type 2 diabetes registered in the Swedish National Diabetes Registry between 1998 and 2012. This cohort was matched with nearly 1.6 million controls from the general population and followed from 1998 to 2013 for CVD outcomes and to 2014 for mortality.
Outcomes of interest included total mortality, CV mortality, non-CV mortality, CHD, acute MI, stroke, HF and atrial fibrillation, Sattar and colleagues wrote. Life expectancy by age of diagnosis was also examined.
The researchers found, during a median follow-up period of 2.5 years, patients younger than 40 years diagnosed with type 2 diabetes had the highest risk relative to controls for total mortality (adjusted HR = 2.05; 95% CI, 1.81-2.83) and CV-related mortality (aHR = 2.72; 95% CI, 2.13-3.48). These patients also had higher excess risk for non-CV mortality (aHR = 1.95; 95% CI, 1.68-2.25), HF (aHR = 4.77; 95% CI, 3.86-5.89) and CHD (aHR = 4.33; 95% CI, 3.82-4.91) compared with controls.
Sattar and colleagues discerned that risks reduced progressively by each decade at diagnostic age. Among adults aged 80 years diagnosed with type 2 diabetes, adjusted HRs for CVD and non-CVD mortality were less than 1, with risk for other CVD outcomes substantially lowered.
HRs for most outcomes were numerically greater in younger women with type 2 diabetes, the researchers wrote.
“This suggests we need to be more aggressive in controlling risk factors in younger type 2 diabetes populations and especially in women,” Sattar said in the release. “And, far less effort and resources could be spent screening people 80 or older for type 2 diabetes risk to adopt lifestyle changes to delay their diabetes by several years.” – by Earl Holland Jr.
Disclosures: Sattar reports receiving consultant and speaking fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Novo Nordisk and Sanofi, and a research grant from Boehringer Ingelheim. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Robert H. Eckel, MD
We’re looking at a case cohort study, so there are always limitations to using registries to make conclusions. But nevertheless, the researchers attempted to match as best they could.
I think this is always a challenge.
Overall, it appears that diabetes at a younger age takes its toll. In terms of the CVD, the relative impact at a younger age is less than it is for the other age groups. That’s when you look at the proportion of deaths of all-cause mortality.
So, the percentages of circulatory disorders are less than other age groups. That’s because when people age, in the absence of diabetes, the circulatory system becomes more important.
Compared with controls, it looks like CVD is still more prominent in the younger patients, it’s just over time that grade seems to be a little bit greater in patients with diabetes, but yet still the relative proportion is still relatively small in those that were diagnosed under the age of 40.
The take-home message is that, presumably the younger onset may imply that the ability to control multiple risk factors may, in fact, be modified at a younger age that relates to all-cause mortality including CVD.
I think we need to be more aggressive in screening patients who are at risk for diabetes and trying to prevent diabetes. Prevention of type 2 diabetes is prevention of excess body weight gain. So, I think that’s the place to start.
So maybe more aggressive screening is something we should think about doing. I’m not sure how making a diagnosis of diabetes at a younger age is going to change that, but I assume that, perhaps, it’s going to be associated with more aggressive management.
And, who knows? Maybe surgery is going to find its place ultimately in a more substantial evidence-based recommendation for people with new onset type 2 diabetes at a younger age.
I think keys to prevention in this population include earlier diagnosis, more aggressive management and consideration of a surgical intervention in patients with excess body weight.
This is an observational study, not a randomized controlled trial, but the impact over almost 6 years of observation was that patients who were diagnosed before age 40 need increased attention because their chances of living a normal life span is reduced. That’s for total mortality and also impacts other complications related to diabetes such as CV mortality non-CVD mortality and HF.
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