Early-Onset Type 2 Diabetes 'Not a Benign Condition'

Marlene Busko

December 22, 2017

Younger adults who were newly diagnosed with type 2 diabetes were more likely to have cardiovascular disease (CVD) risk factors — such as severe obesity, hyperlipidemia, low-grade inflammation, physical inactivity, and smoking — compared with adults who developed diabetes later in life, in a national study in Denmark.

The prevalence of these CVD risk factors was highest in patients with early-onset diabetes (age 18 to 45) and decreased stepwise as the age of diabetes diagnosis increased.

The findings, from the national Danish Center for Strategic Research in Type 2 Diabetes (DD2) study, were published December 11 in Diabetes/Metabolism Research and Reviews.

"Importantly," patients with early-onset diabetes also had poorer glycemic control than other patients, even though they had the highest rate of receiving insulin and a noninsulin glucose-lowering agent (10%), Anne Bo, a PhD student in the department of public health, Aarhus University, in Denmark, and colleagues report.

Moreover, 7% of the patients with early-onset type 2 diabetes had retinopathy and 21% had albuminuria, which are "worrisome" levels of these diabetes complications, they note.

The results emphasize that "early-onset type 2 DM is not a benign condition," according to the researchers.

Patients in the youngest subgroup had a mean age of 39 and a median age of 41, Dr Bo told Medscape Medical News in an email, noting that in Denmark, type 2 diabetes is still rare in people younger than 35.

The study suggests that that people who develop type 2 diabetes at a younger age have an unhealthy lifestyle, she added, and "this group needs special attention and counseling to hinder later complications" from diabetes during their lifetime.

Clinicians need to be aware that the rate of diabetes in people in their 20s though 40s is increasing, and it is important to reach "treatment targets in these younger individuals, including both glucose control and control of other risk factors."

T2D Diagnosis Across a Spectrum of Ages

In their paper, Dr Bo and colleagues say epidemiologic studies have shown that patients with early vs later diabetes onset have increased rates of retinopathy, nephropathy, cardiovascular disease, and premature mortality — likely related to a longer lifetime exposure to diabetes.

Such patients also have a higher prevalence of poor glycemic control, hypertension, family history of type 2 diabetes, high LDL cholesterol, and smoking and a lower level of physical activity.

However, the studies tended to dichotomize patients into early- vs late-onset of diabetes (below, or above, age 40 or 45).

To examine the prevalence of CVD risk factors in patients across a spectrum of ages at diagnosis of type 2 diabetes, the researchers identified 5115 patients with incident type 2 diabetes who were enrolled in the DD2 study during 2010–2015.

They grouped the patients into five categories, depending on their age at the time of their diagnosis of type 2 diabetes: 18 to 45 (early onset; 10% of patients), 46 to 55 (21%), 56 to 65 (average onset; 32%), 66 to 75 (29%), and > 75 (late onset; 8%).

Roughly 40% of the patients were women, and close to a quarter of women in the early-onset group had had gestational diabetes.

The prevalence of most risk factors was highest and glycemic control was worst in people with early-onset diabetes.

However, the prevalence of hypertension was roughly the same in each group, about 33%.

Risk Factors, Glycemic Control in Early-, Average-, Late-Onset Diabetes

Risk Factor, Glycemic Control Early-onset diabetes, age 18 to 45 (%) Average-onset diabetes, age 56 to 65 (%) Late-onset diabetes, age > 75 (%)
Family history of type 2 diabetes 64 52 40
Poor glucose control (HbA1c > 9%) 12 7 1
Good glucose control (HbA1c 6.5%–7%) 20 27 35
BMI > 40 19 8 2
Dyslipidemia 90 79 68
Low-grade inflammation (CRP > 3.0 mg/L) 53 38 26
Recommended physical activity* 22 32 35
Daily smoking 24 20 8
*At least 30 minutes of moderate to intense physical activity/day
BMI=body mass index

Target and Treat Younger Type 2 Diabetes Patients

This study suggests that healthcare providers need to offer "education and information that is adapted to younger patients' needs and experiences" and addresses the emotional burden of living with type 2 diabetes for many years, said Dr Bo.

Patients with early-onset diabetes were less likely to receive antihypertensives, lipid-lowering drugs, or anticoagulants, in spite of similar or higher prevalence of risk factors, which suggests there is a possible treatment gap.

"Other studies point to a faster progression to...more than one glucose-lowering drug," she added. "Therefore, there may be a need for more intensive treatment and support to reach the treatment targets among younger patients and a need for awareness about the risk of complications."  

Bariatric surgery might be a treatment option for some very obese patients with type 2 diabetes, but this was outside the scope of the current study.

"Our next studies will deal with how we organize treatment and support services according to the needs of the target group," said senior study author Helle Terkildsen Maindal, professor of health promotion at Aarhus University and research manager at the Steno Diabetes Center Copenhagen, in a statement.

"We can do this by involving the younger patients themselves and their practitioners in the development of the preventive measures and treatment we offer them."

The Danish Center for Strategic Research in Type 2 Diabetes is supported by the Danish Agency for Science, the Danish Health and Medicines Authority, the Danish Diabetes Association, and an unrestricted donation from Novo Nordisk. The current study was funded by grants from the Danish Diabetes Academy, the Novo Nordisk Foundation, the Central Denmark Region, the Riisfort Foundation, and Aarhus University. The researchers have no relevant financial relationships.  

Diabetes Metab Res Rev. Published online December 11, 2017. Abstract

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