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Young-onset diabetes linked to increased risk for hospitalization, mental illness
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Patients with young-onset type 2 diabetes have excess hospitalizations and a substantial mental illness burden before age 40 years, according to data published in Annals of Internal Medicine.
“Young-onset type 2 diabetes is a heterogeneous and aggressive phenotype associated with increased risk for death and complications compared with usual-onset type 2 diabetes. ...The prevalence of young-onset type 2 diabetes is increasing rapidly,” Calvin Ke, MD, from The Chinese University of Hong Kong and Prince of Wales Hospital, and colleagues wrote.
Young-onset diabetes is associated with increased morbidity and mortality and poorly-controlled risk factors; however, how it affects hospitalization rates is unknown, according to the researchers.
Ke and colleagues conducted a prospective cohort study to determine if young-onset type 2 diabetes, defined as onset before age 40 years, is associated with increased hospitalization rates and whether the association differs by age at onset.
The researchers calculated the all-cause and cause-specific hospitalization rates of a population-based cohort and registry-based cohort, including a total of 443,794 patients aged 20 to 75 years from Hong Kong, using the Hong Kong Diabetes Registry. They used negative binomial regression models to estimate the effect of age at onset on hospitalization rate and cumulative bed-days from onset to age 75 years.
Hospitalization rates by attained age were highest among patients with young-onset type 2 diabetes.
For patients in the registry cohort, more than one-third (36.8%) of bed-days before age 40 years among patients with young-onset diabetes were for mental illness.
Adjusted analysis showed that patients with young-onset type 2 diabetes had higher rates of hospitalization for all-cause (aRR = 1.8; 95% CI, 1.7-2), renal disease (aRR = 6.7; 95% CI, 4.2-10.6), diabetes (aRR = 3.7; 95% CI, 3-4.6), cardiovascular symptoms (aRR = 2.1; 95% CI, 1.8-2.5) and infection (aRR = 1.7; 95% CI, 1.4-2.1).
Controlling intensified risk factors in young-onset type 2 diabetes, including HbA1c level (< 6.2%), systolic BP (< 120 mm Hg), LDL cholesterol level (< 2 mmol/L), triglyceride level (< 1.3 mmol/L), waist circumference (85 cm for men and 80 cm for women) and smoking cessation, reduced cumulative bed-days from onset to age 75 years (97 to 65 bed-days) by 33%.
“This large study highlights the evolution of hospitalization during the long course of young-onset type 2 diabetes, with an excess burden of serious mental illness in early adulthood and cardiorenal complications later in life,” Ke and colleagues concluded. “This costly burden is an urgent call for policymakers, payers, patients and health care providers to take action and address this unmet need.”
“An integrated system is needed to identify patients with young-onset type 2 diabetes for comprehensive assessment of physical and psychological health, followed by optimization of cardiometabolic risk factors and individualized care to improve quality of life and reduce the effects of long-term complications on patients, their families, employers and the health care system,” they added. – by Alaina Tedesco
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Merlin Thomas, MBChB, PhD
It is well known that suffering from any chronic disease increases the risk of mental illness. But the pervasive and omnipresent nature of having diabetes increases the mental burden even further, particularly in young adults who already carry the stigma of obesity. Many feel a constant tension between their diabetes and everyday actions, including work, food intake and physical activities.
Consequently, distress, depression and anxiety are very common in young people with diabetes as well as their family. Adolescents and young adults with diabetes are also at risk for eating disorders and self-harm and risk-taking behavior can become significant issues.
Recognizing the important psychological impact of diabetes, modern comprehensive management involves psychological education, regular screening for mental illness and targeted support as required.
Improvements in the ease and utility of glucose management, including continuous glucose monitoring and the provision of insulin pumps have also improved the quality of life for many young people with diabetes, although any new intervention may be associated with some trepidation. Managing anyone with diabetes is as much about optimizing mental health as it is controlling glucose levels.
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