Long-Term Complications and Mortality in Young-Onset Diabetes

Abstract

OBJECTIVETo evaluate long-term clinical outcomes and survival in young-onset type 2 diabetes (T2DM) compared with type 1 diabetes (T1DM) with a similar age of onset.RESEARCH DESIGN AND METHODSRecords from the Royal Prince Alfred Hospital Diabetes Clinical Database, established in 1986, were matched with the Australian National Death Index to establish mortality outcomes for all subjects until June 2011. Clinical and mortality outcomes in 354 patients with T2DM, age of onset between 15 and 30 years (T2DM15–30), were compared with T1DM in several ways but primarily with 470 patients with T1DM with a similar age of onset (T1DM15–30) to minimize the confounding effect of age on outcome.RESULTSFor a median observation period of 21.4 (interquartile range 14–30.7) and 23.4 (15.7–32.4) years for the T2DM and T1DM cohorts, respectively, 71 of 824 patients (8.6%) died. A significant mortality excess was noted in T2DM15–30 (11 vs. 6.8%, P = 0.03), with an increased hazard for death (hazard ratio 2.0 [95% CI 1.2–3.2], P = 0.003). Death for T2DM15–30 occurred after a significantly shorter disease duration (26.9 [18.1–36.0] vs. 36.5 [24.4–45.4] years, P = 0.01) and at a relatively young age. There were more cardiovascular deaths in T2DM15–30 (50 vs. 30%, P < 0.05). Despite equivalent glycemic control and shorter disease duration, the prevalence of albuminuria and less favorable cardiovascular risk factors were greater in the T2DM15–30 cohort, even soon after diabetes onset. Neuropathy scores and macrovascular complications were also increased in T2DM15–30 (P < 0.0001).CONCLUSIONSYoung-onset T2DM is the more lethal phenotype of diabetes and is associated with a greater mortality, more diabetes complications, and unfavorable cardiovascular disease risk factors when compared with T1DM.

Age-Specific Trends From 2000–2011 in All-Cause and Cause-Specific Mortality in Type 1 and Type 2 Diabetes: A Cohort Study of More Than One Million People

“…Therefore, we believe that the more likely explanation is that young-onset type 2 diabetes represents a more severe form of diabetes. Our data support recently published studies suggesting that young-onset type 2 diabetes is the more lethal phenotype of diabetes and is associated with a greater mortality, more diabetes complications, unfavorable CVD risk factors, and greater difficulty in achieving glycemic control, even compared with type 1 diabetes (33)(34)(35)(36). Given the increasing incidence of young-onset type 2 diabetes and its severity, there is an urgent need for diabetes prevention efforts to be targeted toward youth.…”

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

“…The TODAY study, a large US multicentre randomised clinical trial comparing treatment options for 699 10-to 17-year-olds with type 2 diabetes, found that therapy based on current clinical practice guidelines [6] (metformin plus lifestyle intervention) was ineffective for maintaining glycaemic control in nearly 50% of participants after 1 year of treatment, despite 6 months of weekly face-to-face sessions [36]; hence, the TODAY study, together with the evidence for early diabetes-related complications [3,4], highlights the need for aggressive therapies that commence immediately or early after diagnosis. Bariatric surgery may be a feasible alternative, with one study demonstrating reversal of type 2 diabetes in ten of 11 adolescents [37].…”

“…The prevalence of type 2 diabetes in young people is increasing in some populations [1,2], and the aggressive clinical course is evident [3,4]. Current treatment guidelines aim to optimise glycaemic control and prevent complications through lifestyle intervention with metformin therapy [5,6].…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…401 There is mounting evidence for a very high relative risk in younger individuals with type 2 DM (age ,40 years), 402 and additional guidance on care is needed. Except for glucose management, prevention of CVD follows the same general principles as for people without DM.…”