Disclosures: Zoungas reports she has received advisory or other fees paid to her institution from AstraZeneca, Boehringer Ingelheim, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
December 17, 2020
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Younger age at type 2 diabetes diagnosis drives greater mortality, CV risk

Disclosures: Zoungas reports she has received advisory or other fees paid to her institution from AstraZeneca, Boehringer Ingelheim, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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Increasing age at type 2 diabetes diagnosis is associated with progressively lower risks for all-cause mortality, macrovascular and microvascular disease, according to findings from a systematic review of 26 studies.

Sophia Zoungas

“As early intensive multifactorial risk factor intervention is important for the prevention of long-term macrovascular complications among people with newly diagnosed diabetes, our findings further suggest that this should be sustained long term to minimize risks over time,” Sophia Zoungas, MBBS (Hons), PhD, FRACP, professorial chair of diabetes, vascular health and aging and head of the division of metabolism, aging and genomics at Monash University School of Public Health and Preventive Medicine in Melbourne, Australia, told Healio. “Refined stratification, using age at diagnosis, may provide a method of identifying from diagnosis those at greatest risk for complications who would most benefit from targeted, individualized treatment regimens.”

The odds for all-cause mortality, macrovascular and microvascular complications decrease with each 1-year increase in age at type 2 diabetes diagnosis.

Zoungas and colleagues analyzed data from 26 observational studies with 1,325,493 adults with type 2 diabetes from 30 countries, conducted through July 2018 (mean age range of participants, 22 to 67 years). Studies assessed the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications. Researchers used random-effects meta-analyses with inverse variance weighting to calculate pooled ORs.

“If data [across studies] were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs per 1-year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest,” the researchers wrote.

Researchers found that age at diabetes diagnosis was inversely associated with risk for all-cause mortality and macrovascular and microvascular disease (P < .001 for all).

Data from five studies showed that each 1-year increase in age at diabetes diagnosis was associated with a 4% decreased risk for all-cause mortality, with an OR of 0.96 (95% CI, 0.94-0.99). Data from eight studies showed that each 1-year increase in age at diabetes diagnosis was associated with a 3% decrease for macrovascular disease, with an OR of 0.97 (95% CI, 0.96-0.98). In assessing microvascular disease across eight studies, researchers found that each 1-year increase in age at diagnosis was associated with a 5% decreased risk, with an OR of 0.95 (95% CI, 0.94-0.96). All results persisted after adjustment for current age.

Assessing data from individual vascular complications across 13 studies, researchers found that each 1-year increase in age at diabetes diagnosis was associated with a 2% decreased risk for coronary heart disease (OR = 0.98; 95% CI, 0.97-0.98), a 2% decreased risk for cerebrovascular disease (OR = 0.98; 95% CI, 0.97-0.99) and a 3% decrease risk for peripheral vascular disease (OR = 0.97; 95% CI, 0.96-0.99). Researchers observed similar findings for decreased risk for retinopathy and neuropathy (P < .001 for both).

“Identification and quantification of the higher risk of mortality and vascular disease conferred by younger age at type 2 diabetes diagnosis may enable risk stratification of people early in the condition, providing greater opportunities for interventions to reduce risk of adverse outcomes,” they wrote.

In a press release announcing the findings, the researchers noted that good glucose and risk factor control is of particular importance across the life span.

“This difference in risk between younger and older people in terms of absolute vs. lifetime risks of type 2 diabetes complications, should perhaps be recognized in diabetes management guidelines, with increased promotion of screening programs in older people with type 2 diabetes and a greater emphasis on preventive measures for younger people with type 2 diabetes,” the researchers said in the release.

For more information:

Sophia Zoungas, MBBS (Hons), PhD, FRACP, can be reached at Sophia.zoungas@monash.edu.