Similar burden of type 2 diabetes among adult patients with sickle cell disease relative to African Americans in the U.S. population: a six‐year population‐based cohort analysis

Abstract

Summary Conflicting evidence exists on the epidemiology of type 2 diabetes mellitus (T2DM) among patients with sickle cell disease (SCD). This study measured the prevalence, incidence and clinical outcomes associated with T2DM in a large US population of commercially‐insured adults aged ≥20 years with SCD between 2009 and 2014. Among 7070 patients with SCD, the mean age (median) was 39 (37) years and 60·8% were female. The standardized prevalence of T2DM among patients with SCD showed a modest increase, from 15·7% to 16·5% (P trend = 0·026), and was comparable to African‐American respondents to the National Health and Nutrition Examination Survey (18·2%). Over 17 024 person‐years, the crude incidence rate for T2DM was 25·4 per 1000 person‐years. Incident T2DM was associated with comorbid hypertension (hazard ratio [HR] = 1·45, 95% confidence interval [CI] 1·14–1·83), and dyslipidaemia (HR = 1·43, 95%CI 1·04–1·96). Compared to SCD patients without T2DM, more SCD patients with T2DM had diagnoses of nephropathy (28·0% vs. 9·5%; P < 0·001), neuropathy (17·7% vs. 5·2%; P < 0·001) and stroke (24·1% vs. 9·2%; P < 0·001). Prevalence of T2DM in SCD patients is similar to the general African American population with an increasing trend in recent years. These trends support routine screening for T2DM in aging patients with SCD, especially those with comorbid hypertension and/or dyslipidaemia.

Type 2 diabetes in adults with sickle cell disease: can we dive deeper?

“…For this reason, individuals with SCD were historically considered to be at low risk of developing type 2 diabetes (T2D) (Ballas, ). However, the intriguing findings of Zhou et al () revealed that the prevalence of T2D in SCD patients in the US is now comparable to the prevalence of T2D among the general African‐American population. Furthermore, age, hypertension and dyslipidaemia were all positively associated with T2D among SCD patients (Zhou et al , ).…”

“…However, the intriguing findings of Zhou et al () revealed that the prevalence of T2D in SCD patients in the US is now comparable to the prevalence of T2D among the general African‐American population. Furthermore, age, hypertension and dyslipidaemia were all positively associated with T2D among SCD patients (Zhou et al , ). These remarkable findings provide crucial information for clinicians about the importance of screening for T2D in aging patients with SCD, particularly in those with hypertension or dyslipidaemia (Zhou et al , ).…”

“…Furthermore, age, hypertension and dyslipidaemia were all positively associated with T2D among SCD patients (Zhou et al , ). These remarkable findings provide crucial information for clinicians about the importance of screening for T2D in aging patients with SCD, particularly in those with hypertension or dyslipidaemia (Zhou et al , ).…”

“…One of the strengths of the study reported by Zhou et al () was the large number of subjects with SCD included in the analyses. A total of 7070 adults with SCA, HbSC, HbSβ‐thalassaemia or “other SCD” were all included in the SCD group (Zhou et al , ). However, it is well recognized that the different SCD genotypes vary widely in disease severity, and in the number and nature of SCD complications.…”

“…Finally, HbSβ + ‐thalassaemia is generally considered to be less severe than SCA, HbSC, and HbSβ 0 ‐thalassaemia (Chang et al , ). In light of the findings of Zhou et al (), which showed that SCD subjects with T2D were older and had lower rates of VOC and ACS compared to those without T2D, and the fact that life expectancy and risk of VOC and ACS vary between the SCD genotypes, it would be pertinent to determine whether the prevalence of T2D differs among the different genotypes included in SCD population studied by Zhou et al ().…”