Incidence of Type 2 Diabetes Up in Younger People and Risks Greater 

Becky McCall

September 19, 2019

BARCELONA - The proportion of younger adults (18-40 years) diagnosed with type 2 diabetes has risen from 9.5% to 12.5% since the year 2000, with younger diabetics having higher cardiovascular (CV) risk factors compared with older people with the disease, finds a study of UK primary care data.

Type 2 diabetes incidence in people aged 41-50 years also increased from 14% to 17.5% over the 17 years of the study that began in 2000. CV morbidity and all cause mortality rates remained stable in younger age groups after 2005, even while mortality rates declined substantially among patients aged over 60.

Effectively, in the UK today, around 1 in 8 new cases of type 2 diabetes is in someone aged 18-40 years, compared with 1 in 10 in the year 2000.

The findings add to a growing body of evidence of an increased incidence of type 2 diabetes including worrying complications in younger people. Earlier this year, Medscape Medical News reported how young people diagnosed with type 2 diabetes in their early teens had an "alarming" high rate of diabetes-associated complications by the time they were in their mid-20s. Another study reported results showing that early treatment in teens with prediabetes or recent-onset type 2 diabetes failed to prevent deterioration in beta-cell function.

Sanjoy Ketan Paul, PhD, chair in clinical epidemiology, biostatistics & health services research, and Digsu Koye, PhD, clinical epidemiologist, both from the University of Melbourne, Australia, presented the results at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD).

"The very high HbA1c of 8.6% in the youngest group, with 71% obese, and around 72% with high LDL [low-density lipoprotein] levels, suggests we need to review our whole approach to screening in the UK and the wider world," said Paul.

"Type 2 diabetes doesn’t happen overnight but develops over time with high risk exposure leading to the development of the disease at young age," he added. "We need to be more proactive in the holistic management of cardiovascular and cardiometabolic risk factors such as blood pressure, lipids and so on, in addition to lifestyle management and use intensive therapeutic interventions to manage these risk factors in this age group."

Incidence in Young People Versus Older Age Groups

The study looked at the incidence of type 2 diabetes in the UK population over time, in particular at young onset type 2 diabetes compared with later onset; trends over time in the incidence of atherosclerotic CV disease (ASCVD) by age group; as well as the risk of ASCVD and all-cause mortality by risk status at time of diabetes diagnosis in each age group.

"We don’t really know what is happening to the incidence of type 2 diabetes over time in younger compared with older people, and what the risk factors are at time of diagnosis. Also, do those diagnosed early on have a higher risk of developing CVD, different to the risk in older people?" Paul said. This study addressed these outstanding research issues.

Data were analysed on 343,714 people. Five age groups were evaluated: 18-40, 41-50, 51-60, 61-70 and 71-80 years.  Patients did not have ASCVD at diagnosis.

The youngest group (18-39 years) had significantly higher body mass index (BMI) compared with older age groups, with a mean of 35 kg/m2, and 71% were obese. Their mean HbA1c was 8.6% with 58% having levels ≥ 7.5%, and 71% had LDL levels ≥ 100 mg/dL.  

In comparison, among those in the 41-50 year age group, 70% were obese, with a mean BMI of 34 kg/m2 and 55% had HbA1c of ≥ 7.5%

Data on anthropometric, clinical and laboratory measures, as well as comorbidities atdiagnosis of type 2 diabetes, microvascular disease and all-cause mortality were measured over a median follow-up of 7 years.

Trends Over Time (2000-2017)

Trends over time in the proportion of people with a type 2 diabetes diagnosis in all the age groups were evaluated from 2000 to 2017, as well as the temporal trend for ASCVD and all-cause mortality.

"The temporal patterns show that the incidence of type 2 diabetes has been consistent over the past 5 to 7 years, with a marginal increase in the young onset people, at around 6% in 2006/7 and 8% at the end of the follow-up period," said Paul.

Women showed a striking trend over time. "In the youngest age group (18-40 years), females have a higher incidence of type 2 diabetes diagnosis, compared with a consistently reduced incidence in females in the 40-50 and 50-60 years age groups," he highlighted.

After diagnosis, the rate of development of ASCVD remained similar post-2007, following a decline since the year 2000, across all age groups.

The rate of all-cause mortality remained unchanged among those under-60 but declined in the 60+ age group, decreasing by around 20% in the 60-70 years group and 30% in 70-80 years group.

In the youngest group, the time to a first ASCVD event was the same irrespective of risk level at diagnosis. However, in older people (40 years +) there was a clear difference of around 2 years in development of ASCVD between high-risk and non-high-risk patients. "Similarly, in terms of time to death [all-cause mortality], in the youngest age group, the time to all-cause mortality is similar, but in the older groups there was a difference again."

Commenting from the audience, Dr Roy Taylor, professor of medicine and metabolism, University of Newcastle, said: "These are interesting data. The decreased incidence in the oldest age group is of interest but surely this is an effect of earlier diagnosis of type 2 diabetes with increasing adiposity in the population over recent decades."

Dr Naveed Sattar, from the University of Glasgow, who was moderating the session pointed out that, "It was likely that we are screening less and we are missing a lot of people at younger age. Because of the level of acquisition we are probably not capturing everyone in the community." 

EASD 2019 Annual Meeting. Presented September 18, 2019. Abstract #82

COI: Dr Paul reported no relevant disclosures.

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