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Clinical, behavioral diabetes risk factors high in early onset of disease

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December 15, 2017

Adults with type 2 diabetes who are diagnosed at age 45 years or younger are more likely to have poor glucose control, increased BMI and dyslipidemia compared with adults who are diagnosed at age 46 years or older, study data show.

“When patients are already affected by type 2 diabetes at such a young age, the damage can develop into blindness, kidney failure or life-threatening cardiovascular diseases, as they must live with the disease for decades,” Anne Bo, MSc, a PhD student in the department of public health at Aarhus University in Denmark, said in a press release. “The study therefore provides vital knowledge about the group’s risk factors, which means that the health care system can initiate better and more targeted prevention. We know from previous studies that persons with type 2 diabetes who receive proper treatment have a lower risk of death from heart disease. Consequently, early intervention is so important.”

Bo and colleagues evaluated data from the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort on 5,115 adults (median age, 62.2 years) with incident type 2 diabetes enrolled between 2010 and 2015 to evaluate the association between early onset of type 2 diabetes and clinical and behavioral risk factors for later diabetes complications.

Participants were divided into five groups based on age at diagnosis: 45 years or younger (early onset; 42.2% women), 46 to 55 years (39.5% women), 56 to 65 years (average onset; reference group; 42% women), 66 to 75 years (40.9% women) and older than 75 years (late onset; 49% women).

The prevalence of poor glucose control (HbA1c 9%) was higher in the early-onset group (12%) compared with the average (7%) and late-onset (1%) groups. The prevalence of good glucose control (HbA1c 6.5%-7%) was highest in the late-onset group (35%) followed by the average-onset (27%) and early-onset (20%) groups.

Thirty-nine percent of the early-onset group had BMI greater than 35 kg/m2; 88% had central obesity, 32% had hypertension, 50% had LDL cholesterol level above 2.5 mmol/L and 53% had C-reactive protein (CRP) level above 3 mg/dL. The prevalence of BMI greater than 40 kg/m2 was highest in the early-onset group (19%) followed by the average-onset (8%) and late-onset (2%) groups. The early-onset group also had the highest prevalence of dyslipidemia and CRP above 3 mg/dL.

The prevalence of daily smoking was lowest in the late-onset group (8%) followed by the average-onset (20%) and early-onset (24%) groups. The prevalence of self-reported high-risk alcohol intake was less than 10% in all groups.

The prevalence of using no glucose-lowering drugs was highest in the late-onset group (22%) compared with the average-onset (15%) and early-onset (8%) groups. The prevalence of the use of insulin and non-insulin drugs was highest in the early-onset group (11%) followed by the average-onset (6%) and late-onset (2%) groups. However, use of antihypertensive drugs, lipid-lowering drugs and anticoagulants increased with increasing age of diabetes onset.

“We can see from the study that the younger sufferers are generally receiving too little treatment,” Bo said. “They receive far less preventive treatment with medicine such as antihypertensive medicine, lipid-lowering medicine and anticoagulants. In addition, they have stated that they exercise less and smoke more than the elderly patients. This points towards a need to rethink the way the health care sector organizes type 2 diabetes treatment, and not least, how the younger type 2 diabetes patients are met by health care professionals.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.