'Hidden' Danger of Type 2 Diabetes Diagnosis at Early Age

Miriam E. Tucker

December 28, 2020

Those who are found to have type 2 diabetes at a younger age face "hidden" dangers. The issue is becoming more and more important, "since new diagnoses in this younger age group continue to rise," say the authors of a new study, led by Natalie Nanayakkara, MD.

They believe clinical approaches should be based on age at diagnosis. The results of their new meta-analysis, published online in Diabetologia, reveal the extent of the problem.

Believed to be the first systematic review of its kind, the study shows that the younger the age at diagnosis of type 2 diabetes, the greater the risks of dying and of having either microvascular or macrovascular complications each subsequent year (adjusted for current age).

"This difference in risk between younger and older people in terms of absolute vs lifetime risks of type 2 diabetes complications should perhaps be recognised in diabetes management guidelines," stress Nanayakkara, an endocrinologist at the School Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and colleagues.

Those diagnosed at younger ages are more likely to develop complications that cause greater disability and lead to loss of productivity compared with people diagnosed at an older age, they stress.

Hence, they suggest "a greater emphasis on preventive measures for younger people with type 2 diabetes," with "early intensive multifactorial risk factor intervention...sustained long-term to minimise risks over time."

Large Dataset: Use Age at Diagnosis to Risk Stratify Patients

Rates of type 2 diabetes have increased in all age groups and virtually all countries over the past three decades. Particularly worrying is a trend toward increased rates among adults aged 20 to 44 years. The increases are associated with higher rates of overweight and obesity, poor diet, and decreasing levels of physical activity, numerous studies have shown.

But few studies have examined the association between age at diagnosis and subsequent complications from type 2 diabetes, the authors note.

Their review included 26 observational studies involving more than one million individuals from 30 countries in the Asia Pacific, Europe, and North America. The investigators found that each 1-year increase in age at diabetes diagnosis was significantly associated with a 4%, 3%, and 5% decreased risk for all-cause mortality, macrovascular disease, and microvascular disease, respectively, adjusted for current age (all P < .001).

Similar decreases in risk per 1-year increase in age at diabetes diagnosis were seen for coronary heart disease (2%), cerebrovascular disease (2%), peripheral vascular disease (3%), retinopathy (8%), nephropathy (6%), and neuropathy (5%); all associations were significant (P < .001).

Nanayakkara and colleagues note that current treatment guidelines are limited in that they're related to the management of patients with suboptimal blood glucose control, and there is no way to predict which people require intensified treatment.

Therefore, they say, "Refined stratification using age at diagnosis may provide a method of identifying, at diagnosis, those at greatest risk of complications who would most benefit from targeted, individualised treatment regimens."

Awareness of this "hidden" danger to younger adults with type 2 diabetes is becoming more and more important, because such cases continue to rise, they reiterate.

They also advise that "public health measures to delay and/or prevent the onset of type 2 diabetes until older age may yield benefits by reducing the duration of diabetes and the burden of complications."

Nanayakkara has disclosed no relevant financial relationships. The original article has a listing of coauthors' relationships with industry.

Diabetologia. Published online December 14, 2020. Full text

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