Young-onset type 2 diabetes mellitus — implications for morbidity and mortality

Magliano, Dianna J.; Sacre, Julian W.; Harding, Jessica L.; Gregg, Edward W.; Zimmet, Paul; Shaw, Jonathan E.

doi:10.1038/s41574-020-0334-z

Cited by 256 publications

(206 citation statements)

References 134 publications

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“…The majority of early-onset diabetes cases are patients with type 2 diabetes. This phenotype is common in Mexico; it is characterized for having a more aggressive form of the disease usually associated with obesity, rapidly declining β-cell function, higher risk of microvascular complications compared to late-onset type 2 diabetes [15]. We considered this form of diabetes given its high prevalence in Mexican and other populations as well as its higher propensity for complications [16,17].…”

Section: Definitions Of Suspected and Confirmed Covid-19 Casesmentioning

confidence: 99%

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Bello‐Chavolla

Bahena-López

Antonio-Villa

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

397

400

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Abstract Background The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. Methods We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. Results Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age ≥ 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). Conclusions Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.

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Section: Definitions Of Suspected and Confirmed Covid-19 Casesmentioning

confidence: 99%

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Bello‐Chavolla

Bahena-López

Antonio-Villa

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

397

400

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“…Therefore, the use of DPP-4 inhibitors may attenuate β-cell deterioration; by contrast, SUs tend to exhaust β-cell function [28]. This may be particularly important in people with YOD and a rapid decline of β-cell function [25]. Our subgroup analysis further suggested that add-on DPP-4 inhibitors in people with YOD may be as early with young and low complications as better.…”

Section: Resultsmentioning

confidence: 69%

“…Prevailing evidence suggests that adults with YOD show more rapid β-cell deterioration than those with late-onset T2DM [25]. By prolonging the half-life of glucagon-like peptide-1 and gastric inhibitory polypeptide, DPP-4 inhibitors promote glucose-dependent insulin secretion and are believed to have a βcell preserving function [26,27].…”

Section: Resultsmentioning

confidence: 99%

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Yen

Wei

Liu

et al. 2020

Preprint

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Background: People with young-onset diabetes (YOD) exhibit a higher risk of morbidity and mortality than those with late-onset diabetes. Few studies have explored the preferred management of diabetes in such patients; therefore, we compared the risks of hospitalization and mortality among people with YOD to whom second-line oral antidiabetic drugs (OADs) were administered.Methods: We conducted a nationwide cohort study using the National Health Insurance Research Database (Taiwan). A total of 7257 people taking second-line OADs after initial metformin therapy were enrolled during 2009–2014. Using add-on sulfonylureas (SUs) as a reference, the multivariable Cox regression model was used to compare the risks of hospitalization and mortality among 5 categories of second-line OADs: alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones.Results: The mean age of patients, duration of diabetes, and follow-up period were 31.6, 3.3, and 1.9 years, respectively. After baseline characteristics, comorbidities, duration of diabetes, and cardiovascular drug use were controlled, the adjusted hazard ratios and 95% confidence interval for all-cause, cardiovascular, and non-infection hospitalization and all-cause mortality for metformin plus DPP-4 inhibitors were 0.62 (0.52–0.73), 0.49 (0.29–0.85), 0.64 (0.54–0.76), and 0.50 (0.27–0.92), respectively, when compared with the data for metformin plus SUs.Conclusions: We found that among people with YOD, taking add-on DPP-4 inhibitors was associated with lower risks of all-cause hospitalization and mortality than taking add-on SUs. DPP-4 inhibitors thus seem to be a suitable second-line OAD for such patients.Trial registration: retrospectively registered

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“…A younger age of T2DM diagnosis was associated with poor self-management and medication adherence, increased stress, and depressive symptoms [28,29] . In addition, genetic factors might play an important role in young-onset T2DM by affecting beta-cell development [30,31] . Management Algorithm [32] recommend less aggressive risk management in individuals with diabetes aged < 40 years.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Age at Diagnosis of Type 2 Diabetes and Albuminuria in Chinese Adults

Liu

Zhao

et al. 2020

Preprint

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Background: Type 2 diabetes is increasingly diagnosed at a younger age worldwide and in China. Limited data are available regarding the association between age at diabetes diagnosis and risks of albuminuria, which is a common microvascular complication in diabetes patients. In addition, few studies on age at diagnosis and outcomes have fully accounted for the complex interplay between age at diagnosis and the actual age or diabetes duration, all of which are independently associated with vascular risks.Methods: We used data from a nationwide multicenter study with 207,961 participants recruited from 25 communities across mainland China during 2010-2012. Age, sex, and study sites were matched for 31,366 screen-detected type 2 diabetes and 31,366 normal controls. Age, sex, study sites, and diabetes duration were matched for 7,490 self-reported type 2 diabetes and 7,490 normal controls. Risks of having albuminuria in matched type 2 diabetes vs. normal controls were examined using multivariable logistic regression analysis in strata of age at type 2 diabetes diagnosis (<50, 50-59, 60-69, or ≥70 years). Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g.Results: Percentages of albuminuria were significantly higher among type 2 diabetes patients compared with normal controls in each stratum of age at diagnosis. Although the absolute rate of albuminuria is higher in older adults, the odds ratio of albuminuria in type 2 diabetes vs. matched controls decreased with increasing age at diagnosis. For participants with diabetes diagnosed at an age of <50, 50-59, 60-69, or ≥70 years, the multivariable adjusted risk of albuminuria increased by 81%, 60%, 45%, and 33% for screen-detected diabetes, and 135%, 121%, 90%, and 58% for self-reported diabetes compared with their normal controls, respectively. Conclusions: A younger age at diagnosis of type 2 diabetes is associated with a more significantly elevated risk of albuminuria than an older age at diagnosis in Chinese adults.

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Young-onset type 2 diabetes mellitus — implications for morbidity and mortality

Cited by 256 publications

References 134 publications

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

The Association Between Age at Diagnosis of Type 2 Diabetes and Albuminuria in Chinese Adults

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Young-onset type 2 diabetes mellitus — implications for morbidity and mortality

Cited by 256 publications

References 134 publications

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

The&nbsp;Association&nbsp;Between&nbsp;Age at Diagnosis of Type 2 Diabetes and Albuminuria&nbsp;in Chinese Adults

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The Association Between Age at Diagnosis of Type 2 Diabetes and Albuminuria in Chinese Adults