Early-onset type 2 diabetes risk elevated for South Asian, African Caribbean adults
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South Asian and African Caribbean adults living in north west London are more likely to be diagnosed with early-onset type 2 diabetes than white adults, according to a speaker.
“We know that early-onset type 2 diabetes is associated with a higher risk of cardiovascular events and a greater year of life lost compared to those diagnosed later in life,” Shivani Misra, MD, PhD, honorary senior clinical lecturer at Imperial College London and a consultant physician in metabolic medicine and diabetes at Imperial College Healthcare NHS Trust, told Healio. “Whilst some pediatric studies have looked at the ethnic breakdown of type 2 diabetes in youth, the ethnicity distribution of early-onset type 2 diabetes in adults and relationship with BMI has not been studied. Since we know South Asian and African Caribbean [people] have a higher risk of later-onset type 2 diabetes compared to white individuals, we aimed to study in detail what was happening to people from these ethnic groups in early adulthood — was it the same as later-onset or different?”
Misra and colleagues presented the findings at the European Association for the Study of Diabetes virtual meeting.
Early-onset type 2 diabetes prevalence
Researchers conducted a cross-sectional study of adults with type 2 diabetes from general practice records in north west London from April 2015 to 2019. Participants were categorized as having early-onset type 2 diabetes if they were aged 18 to 45 years at the time of diagnosis. Researchers examined the number of early-onset type 2 diabetes diagnoses by age within the white, South Asian and African Caribbean ethnic groups. Mean BMI was also compared for each ethnicity between adults aged 18 to 45 years and those aged 55 to 79 years with a diabetes duration of less than 5 years.
Across all age groups, adults with South Asian ethnicity had the highest prevalence for type 2 diabetes at 10.1%, followed by African Caribbean adults at 8.3% and white adults at 3.4%. However, early-onset type 2 diabetes prevalence was disproportionally higher in the South Asian and African Caribbean groups. South Asian people had the highest prevalence with more than 30% of cases categorized as early-onset — 8.2% were diagnosed at age 18 to 34 years and 22.5% at age 35 to 44 years.
“The numbers surprised me; in north west London just under 18,000 South Asian people living with type 2 diabetes were diagnosed between [ages] 18 and 44 years,” Misra said “That’s a huge number, which is only rising. If we fast forward and think about these individuals being at higher risk of complications in the future, we have a major health crisis on our hands.”
About one-quarter of all type 2 diabetes cases in the African Caribbean group were early-onset, with 7.2% of cases diagnosed at age 18 to 34 years and 18.6% at age 35 to 44 years. White adults had the lowest percentage of early-onset type 2 diabetes with 3.7% diagnosed at age 18 to 34 years and 12% at age 35 to 44 years. By contrast, at age 55 years and older, white adults had a higher percentage of type 2 diabetes diagnoses than either South Asian or African Caribbean adults.
Obesity and early-onset type 2 diabetes
Among all three ethnic groups, BMI was higher for those aged 18 to 44 years with type 2 diabetes than those aged 55 to 79 years who had diabetes for less than 5 years. White adults had the highest mean BMI (34.8 kg/m2 for those aged 18-45 years vs. 31.8 kg/m2 for those aged 55-79 years), followed by African Caribbean people (33.7 kg/m2 for those aged 18-45 years vs. 31 kg/m2 for those aged 55-79 years). Among South Asian adults, BMI was significantly lower than for white adults, despite the higher prevalence of overall and early-onset type 2 diabetes (30.3 kg/m2 for those aged 18-45 years vs. 28.6 kg/m2 for those aged 55-79 years).
“The early-onset adult type 2 diabetes presentation, compared to later-onset, is significantly associated with obesity in all ethnic groups,” Misra said. “But out of the three ethnic groups, South Asian people develop type 2 diabetes at the lowest BMI. We also find that within the 18- to 44-year age bracket, the highest level of obesity is biased to the younger ages, with BMI gradually reducing as age-of-onset advances.”
The study’s findings reveal the importance for providers to put a greater focus on managing and preventing early-onset type 2 diabetes among young South Asian and African Caribbean adults, according to Misra.
“This is an extremely high-risk group, and currently no guidelines, national or international, have a clear strategy of how to address their cardiovascular risk or what the best treatment is,” Misra said. “We know from other studies in the U.K., that people with early-onset type 2 diabetes are less likely to meet treatment targets and engage with health care professionals. We urgently need studies that look at the best way of supporting and treating these individuals, and in the meantime, we need to think carefully about the best management strategy — clearly the needs of a 22-year-old with type 2 diabetes are very different from a 62-year-old.
“The other impact relates to prevention of type 2 diabetes in these groups,” Misra added. “We have national strategies in the U.K. that aim to prevent and reverse type 2 diabetes, and it will be interesting to see if these can be extrapolated to the younger-onset group with equal efficacy.”
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Ranchagoda JD, et al. Oral Abstract #153. Presented at: EASD Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
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