Diabetes incidence higher among young people with vs. without Down syndrome
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Children, adolescents and young adults with Down syndrome have higher incidence rates of type 1 and type 2 diabetes compared with matched controls without Down syndrome, according to a study published in Diabetes Care.
“Children and young adults with Down syndrome are four times more likely to have diabetes and experience significant obesity at earlier ages,” Andre Strydom, MBChB, MRCPsych, PhD, professor of intellectual disabilities in the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, and Li Chan, MB, BChir, MRCPCH, PhD, reader in molecular endocrinology and metabolism and honorary consultant in pediatric endocrinology at The William Harvey Research Institute – Faculty of Medicine at Dentistry at Queen Mary University of London, told Healio. “Type 2 diabetes was particularly common in the young individuals with Down syndrome compared to their peers in the general population.”
Researchers conducted a population-based cohort study using data collected from the U.K. Clinical Practice Research Datalink GOLD database from 1990 to 2020. People with Down syndrome were matched by family practice, sex, birth year and calendar date of the start of their health record with up to four controls without Down syndrome. Both type 1 and type 2 diabetes diagnoses were identified. WHO BMI categories were used to classify participants into underweight, normal weight, overweight or obesity groups. Diabetes incidence rates per 1,000 person-years were compared between the Down syndrome and control cohorts as well as within age, sex and time period subgroups.
The study cohort included 9,917 people with Down syndrome and 38,266 controls without Down syndrome. There were 287 new diagnoses of diabetes in the Down syndrome group, of which 12.9% were type 1 diabetes and 87.9% were type 2 diabetes. The control group had 1,254 new diagnoses of diabetes, of which 3.9% were type 1 diabetes and 96.1% were type 2 diabetes. Overall diabetes incidence was higher among those with Down syndrome than healthy controls (incidence rate ratio [IRR] = 3.67; 95% CI, 2.43-5.55; P < .0001).
Cases of diabetes increased in both groups over time. The diabetes incidence rate among those with Down syndrome increased from 1.29 per 1,000 person-years in 1990 to 1999 to 4.4 per 1,000 person-years in 2010 to 2020. Among controls, the diabetes incidence rate increased from 1.16 per 1,000 person-years from 1990 to 1999 to 4.3 per 1,000 person-years in 2010 to 2020.
Diabetes incidence highest among young people with Down syndrome
The Down syndrome group had higher diabetes incidence rates than controls among children and adolescents aged 5 to 14 years (1.55 vs. 0.38 per 1,000 person-years), teens and young adults aged 15 to 24 years (2.75 vs. 0.68 per 1,000 person-years), adults aged 25 to 34 years (3.86 vs. 1.65 per 1,000 person-years) and adults aged 35 to 44 years (4.7 vs. 2.92 per 1,000 person-years). Incidence rates were similar between the two groups among those aged 45 to 54 years and were higher among controls in older age groups.
Type 1 diabetes incidence rates were highest among people with Down syndrome aged 15 to 24 years compared with controls (1.13 vs. 0.18 per 1,000 person-years). For type 2 diabetes, incidence rates were highest among those with Down syndrome aged 5 to 14 years compared with controls (0.62 vs. 0.06 per 1,000 person-years). Type 2 diabetes incidence rates remained higher among people with Down syndrome compared with controls up to age 34 years. Among those aged 55 years and older, type 2 diabetes incidence was about twice as high among controls as those with Down syndrome.
“HbA1c is not routinely measured in children and adolescents with Down syndrome,” the researchers wrote. “Our study suggests that they have an additional risk of type 2 diabetes and are also susceptible to the environmental factors driving increased rates of obesity and type 2 diabetes. We would therefore recommend proactive monitoring of HbA1c at annual health checkups in adolescents with Down syndrome.”
Incidence rates increase with higher BMI
Diabetes incidence rates were higher among controls with overweight compared with those with Down syndrome and overweight (7.29 vs. 4.23 per 1,000 person-years) as well as controls with obesity compared with people with Down syndrome and obesity (17.12 vs. 8.07 per 1,000 person-years). No difference in type 1 diabetes incidence was observed in any BMI groups, but incidence rates for type 2 diabetes increased alongside increasing BMI in both the Down syndrome and control groups.
A lower percentage of people with Down syndrome used an oral diabetes medication within 5 years of diagnosis compared with the control group (39% vs. 58%). The Down syndrome group had a larger proportion of people using insulin than the control group (20% vs. 11%).
“The fact that patients with Down syndrome were less likely to be recorded as receiving oral hyperglycemic medication within the first 5 years from diagnosis than control patients was surprising and warrants further investigation,” Strydom and Chan said. “This work is helpful to informing the NHS England’s LeDeR program to reduce inequalities and premature mortality in people with Down Syndrome and learning disabilities.”
The researchers said more research into the genetic predisposition of diabetes and obesity in those with Down syndrome is needed to develop therapies and inform preventive measures.
“We are studying the treatment of diabetes more closely in Down syndrome alongside other morbidities in Down syndrome,” Strydom and Chan said. “The project is part of a wider consortium where we will study factors relating to why Down syndrome is predisposed to metabolic disease. We will also work toward better prevention and screening in Down syndrome.”
For more information:
Li Chan, MB, BChir, MRCPCH, PhD, can be reached at l.chan@qmul.ac.uk.
Andre Strydom, MBChB, MRCPsych, PhD, can be reached at andre.strydom@kcl.ac.uk.
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