Risks for heart disease, disability, death higher with younger age at diabetes diagnosis
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The risk for heart disease, stroke, disability and mortality among adults with diabetes is higher for those diagnosed at age 50 to 59 years than those diagnosed at age 70 years or older, according to study findings.
In an analysis of data from adults aged 50 years and older participating in the Health and Retirement Study in the U.S., adults who reported they were diagnosed with diabetes at age 50 to 59 years had an increased risk for heart disease, stroke, disability, cognitive impairment and mortality compared with matched controls without diabetes, whereas adults diagnosed at age 70 years or older had a higher risk for only mortality compared with controls. Data did not distinguish between type 1 and type 2 diabetes.
“With increasing age at diagnosis, diabetes is associated with significantly decreased risks of incident comorbid outcomes,” Judy Zhong, PhD, associate professor of biostatistics in the department of population health at the New York University Grossman School of Medicine, and colleagues wrote in a study published in JAMA Network Open. “In adults who were younger at diabetes diagnosis, diabetes was significantly associated with an increased HR for each distal outcome. In contrast, the association was not significant for the oldest diagnosis group.”
Researchers collected data from six Health and Retirement Study cohorts from 1995 to 2018. The study included data from 7,739 adults aged 50 years and older who self-reported incident diabetes during a study interview (55.1% women; mean age at diagnosis, 67.42 years) and 28,321 adults who never reported having diabetes. Participants with diabetes were divided into groups based on age at diagnosis of 50 to 59 years, 60 to 69 years and 70 years and older. Adults with diabetes were matched 1:1 with controls by propensity score. Incidence of heart disease and stroke was self-reported. Disability was determined through self-reported activities of daily living dependencies at each interview. A modified version of the Telephone Interview for Cognitive Status was used to measure cognitive impairment. Mortality data were acquired from the National Death Index and Social Security Death Index.
Of those with diabetes, 1,866 were diagnosed at age 50 to 59 years, 2,834 were diagnosed at age 60 to 69 years and 3,039 were diagnosed at age 70 years and older.
Adults diagnosed with diabetes at age 50 to 59 years had an increased risk for heart disease (HR = 1.66; 95% CI, 1.4-1.96; P < .001), stroke (HR = 1.64; 95% CI, 1.3-2.07; P < .001), disability (HR = 2.08; 95% CI, 1.59-2.72; P < .001), cognitive impairment (HR = 1.3; 95% CI, 1.05-1.61; P = .02) and mortality (HR = 1.49; 95% CI, 1.29-1.71; P < .001) compared with matched controls. Adults with diabetes diagnosed at age 60 to 69 years had a higher risk for heart disease (HR = 1.25; 95% CI, 1.1-1.42; P = .001), stroke (HR = 1.41; 95% CI, 1.17-1.69; P < .001) and disability (HR = 1.44; 95% CI, 1.2-1.73; P < .001) compared with matched controls. In the age 70 years and older group, adults with diabetes had a higher risk for mortality compared with matched controls (HR = 1.08; 95% CI, 1.01-1.17; P = .03), but there was no difference in risks for any other outcomes.
Compared with adults diagnosed with diabetes at age 50 to 59 years, those diagnosed at age 70 years or older had a significantly lower risk for heart disease (P = .001), stroke (P = .002), disability (P < .001) and mortality (P < .001).
“The mechanisms that link earlier diabetes diagnosis to worse outcomes are not completely understood,” the researchers wrote. “The longer duration of diabetes in individuals with earlier diagnosis has been reported in several previous studies. In contrast, in our study, the age-at-diagnosis association persisted when diabetes duration was fully adjusted by comparing incident outcomes starting from the age at diabetes diagnosis. Another plausible explanation is that adults who are younger at diagnosis may have a more physiologically aggressive form of diabetes, with worse glycemic control, beta-cell dysfunction, insulin insufficiency, and insulin resistance.”
The researchers said future studies should further examine how metabolic mechanisms, lifestyle and behaviors, social determinants of health and diabetes management interact with age at diabetes diagnosis.
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