Combined associations of family history and self-management with age at diagnosis and cardiometabolic risk in 86,931 patients with type 2 diabetes: Joint Asia Diabetes Evaluation (JADE) Register from 11 countries

Abstract

Background Family history (FamH) of type 2 diabetes might indicate shared genotypes, environments, and/or behaviors. We hypothesize that FamH interacts with unhealthy behaviors to increase the risk of early onset of diabetes and poor cardiometabolic control. Methods In a cross-sectional analysis of the prospective Joint Asia Diabetes Evaluation Register including patients from 427 clinics in 11 Asian countries/regions in 2007–2021, we defined positive FamH as affected parents/siblings and self-management as (1) healthy lifestyles (balanced diet, non-use of alcohol and tobacco, regular physical activity) and (2) regular self-monitoring of blood glucose (SMBG). Results Among 86,931 patients with type 2 diabetes (mean±SD age: 56.6±11.6 years; age at diagnosis of diabetes: 49.8±10.5 years), the prevalence of FamH ranged from 39.1% to 85.3% in different areas with FamH affecting mother being most common (32.5%). The FamH group (n=51,705; 59.5%) was diagnosed 4.6 years earlier than the non-FamH group [mean (95% CI): 47.9 (47.8–48.0) vs. 52.5 (52.4–52.6), logrank p<0.001]. In the FamH group, patients with both parents affected had the earliest age at diagnosis [44.6 (44.5–44.8)], followed by affected single parent [47.7 (47.6–47.8)] and affected siblings only [51.5 (51.3–51.7), logrank p<0.001]. The FamH plus ≥2 healthy lifestyle group had similar age at diagnosis [48.2 (48.1–48.3)] as the non-FamH plus <2 healthy lifestyle group [50.1 (49.8–50.5)]. The FamH group with affected parents had higher odds of hyperglycemia, hypertension, and dyslipidemia than the FamH group with affected siblings, with the lowest odds in the non-FamH group. Self-management (healthy lifestyles plus SMBG) was associated with higher odds of attaining HbA1c<7%, blood pressure<130/80mmHg, and LDL-C<2.6 mmol/L especially in the FamH group (FamH×self-management, pinteraction=0.050–0.001). Conclusions In Asia, FamH was common and associated with young age of diagnosis which might be delayed by healthy lifestyle while self management was associated with better control of cardiometabolic risk factors especially in those with FamH.

Positive parental history of diabetes is associated with early diagnosis, better dietary compliance, and glycemic control among type 2 diabetes patients in southern Sri Lanka

“…In contrast, many previous studies have shown a negative association between family history and glycemic control [ 20 , 30 , 31 ]. However, Cheung et al reported similar findings to those of this study, with 86,931 patients from 11 Asian countries reporting lower HbA 1C among patients with a positive parental history as compared to those with a negative parental history [ 32 ].…”

Advancing the communication of genetic risk for cardiometabolic diseases: a critical interpretive synthesis

“…This can further inform individuals’ willingness and readiness to engage in preventative health behaviours—representing a valuable point of intervention (Table 2 ). Empirical studies have explored how having a family history of diseases such as T2D can interact with health behaviours to affect an individual’s cardiometabolic risk—highlighting the complex relationships between shared genotypes, environments and/or behaviours in informing disease risk [ 51 ]. Qualitative research also shows that participants often discuss risk as being “inherited” via lifestyle and habits from home, cultural or social environments [ 41 – 44 ].…”

RSSDI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2022

“…In addition, other factors, including prenatal factors (e. g., low birth weight, maternal under-nutrition), the biological propensity to central obesity and insulin resistance, low lean mass, diabetes during pregnancy, impaired glucose tolerance, and urban stress are associated with a high prevalence of T2DM in Indian children and young adults. [1167][1168][1169][1170][1171][1172][1173][1174][1175] Data on the prevalence of young onset T2DM are scarce worldwide, especially in India 1176 . It has been estimated that 1 in 3 new cases of diabetes mellitus in the USA diagnosed in youth younger than 18 years is T2DM and is more common among youth between 10 and 19 years of age 1158 .…”