Spotlight on young-onset type 2 diabetes

Some recent studies investigated cardiovascular disease, mortality risk, kidney disease, and the evidence base among patients who develop type 2 diabetes before age 40 or 50 years.

Several recent studies focused on people who develop type 2 diabetes before age 40 or 50 years.

The first study, published by Diabetes Care on July 2, used a British primary care database to analyze 370,854 people with a new diagnosis of type 2 diabetes from 2000 to 2017. It found that a rising proportion of diagnoses occurred in those younger than age 50 years from 2000 to 2010, with stabilization after that. Over the study period, both cardiovascular disease and all-cause mortality declined among patients ages 50 years and older but not among younger patients. Only 2% of the younger patients had cardiovascular disease at diagnosis of diabetes, but 23% were at high risk of developing it. Among patients ages 18 to 39 years, the average time to cardiovascular disease or death was similar between low-risk and high-risk groups. “Unlike usual-onset, young-onset type 2 diabetes has a similar cardiovascular and mortality risk irrespective of cardiometabolic risk factor status at diagnosis,” said the study authors. “In view of substantial high risk and the life years lost in younger patients with type 2 diabetes, there is an urgent need for tight risk factor control and a need for further research on best methods to manage this group. This includes models of care, multifactorial risk factor control, and cardiovascular outcome trials using novel therapies.”

There is a paucity of research to guide the care of patients who develop type 2 diabetes before age 40 years, according to a study published by Diabetologia on June 2. Researchers reviewed 90 prominent trials in type 2 diabetes with a total of 268,978 participants. They found that the mean age of participants was 63 years. Almost a third of the trials entirely excluded people younger than age of 40 years, and researchers estimated that in 73 of the trials, fewer than 5% of the participants were ages 18 to 39 years, although this age group represents between 15% and 20% of the adult type 2 diabetes population. The authors noted that the absence of younger patients from research may not be due entirely to the trials' design. “Other factors, including the often complex busy lives of individuals aged 18-39 years and with potentially differing priorities from those of older adults, may preclude their involvement in clinical research even when eligibility criteria permit their enrolment,” they said. The authors called for research to ensure that the best care for younger patients is identified. “For example, they may benefit from earlier, more aggressive intervention to halt the early development of severe complications, whilst novel approaches to long-term management and ongoing clinical consultation may also be effective.”

Finally, a study published by Diabetes Care on June 15 looked at incidence of end-stage kidney disease (ESKD) by age at diabetes onset. It used an Australian database to analyze 7,592 diagnoses of ESKD between 2002 and 2013. During the first 10 to 15 years following the onset of diabetes, incidence of ESKD was higher in older patients. However, over longer durations of diabetes, the incidence of ESKD was higher in patients who had developed diabetes at a younger age. This was likely due to their longer survival with diabetes and greater uptake of renal replacement therapy, the study authors noted. When patients who died of ESKD without renal replacement therapy were included, the higher incidence in younger-onset patients was no longer found. ESKD incidence rates were higher in males compared to females, particularly in those with onset of diabetes before age 40 years. “This study supports the notion that delaying the onset of type 2 diabetes would be an effective method for reducing the risk of ESKD and also adds to the body of evidence highlighting the urgent requirement for development and implementation of effective interventions that attenuate the progression of [diabetic nephropathy] in type 2 diabetes,” the study authors said.