Early onset type 2 diabetes: Higher burden of risk factors and treatment gap in T2D patients below the age of 45 at diagnosis
A new article published in Diabetes/Metabolism Research and Reviews (December 2017) by Danish Diabetes Academy PhD fellow Anne Bo, Department of public health, Aarhus university, found that risk factors for developing complications following type 2 diabetes are much more common among patients who are diagnosed before the age of 45 than in elderly newly-diagnosed patients.
The common view of type 2 diabetes as an old person’s disease is becoming seriously outdated in step with the increasing number of persons word wide under the age of 45 who develop the disease. This new study adds to international evidence of a worrisome accumulation of risk factors among the early onset type 2 diabetes patients. The findings call for clinical awareness and improved support for this specific target group.
LARGE NATIONWIDE DANSIH COHORT OF NEWLY DIAGNOSED TYPE 2 DIABETES PATIENTS FROM THE DANISH CENTRE FOR STRATEGIC RESEARCH IN TYPE 2 DIABETES
The study is based on 5,115 persons newly diagnosis with type 2 diabetes in hospital outpatient clinics or in general practice. In a cross-sectional study we compared risk factors at time of diagnosis among those diagnosed at ≤45 years (early-onset) with diagnosis age 46-55, 56-65 (average-onset = reference), 66-75, and >75 years (late-onset). Risk factors included anthropometric measurements, HbA1c and fasting blood glucose, lipid levels, blood pressure, CRP as well as retinopathy and microalbuminuria. Moreover, medical treatment and self-reported physical activity and smoking were investigated.
AGE GRADIENT OF INCREASINGLY HIGHER PREVALENCE OF POOR GLUCOSE CONTROL AND OTHER CLINICAL AND BEHAVIOURAL RISK FACTORS WITH YOUNGER AGE AT TYPE 2 DIABETES DIAGNOSIS
Compared with older age groups, persons with early-onset type 2 diabetes had
- a markedly higher prevalence poor glucose control
- higher prevalence of obesity, dyslipidaemia, low-grade inflammation
- higher prevalence of smoking and lower physical activity level
- almost the same prevalence of hypertension
- higher prevalence of retinopathy and same prevalence of microalbuminuria
The early-onset individuals were more likely to receive both insulin and non-insulin glucose lowering treatment but far less likely to receive anticoagulation, antihypertensive and lipid lowering drugs in spite of the adverse risk factor profile among the younger patients.
POSSIBLE FUTURE RISE IN DIABETES COMPLICATIONS DUE TO EARLY ONSET DIABETES
A recent lancet study showed that the overall improvements in diabetes outcomes observed during the last 20 years are primarily due to a reduction in complications among older persons with type 2 diabetes. Therefore, the increased incidence of type 2 diabetes in high-risk young persons could cause a future rise in diabetes complications. Therefore, we need knowledge about how to organise treatment and support services according to the needs of the target group. This could be obtained by involving the younger patients themselves and their practitioners in the development of the preventative measures and treatment we offer them.
AUTHORS AND AFFILIATIONS
Anne Bo1,2, Reimar W. Thomsen3, Jens Steen Nielsen4, Sia Kromann Nicolaisen3, Henning Beck-Nielsen4, Jørgen Rungby5,6, Henrik Toft Sørensen3, Troels Krarup Hansen7, Jens Søndergaard8, Søren Friborg9, Torsten Lauritzen2, Helle Terkildsen Maindal2,10
1Danish Diabetes Academy
2Department of Public Health, Aarhus University, Aarhus, Denmark
3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
4Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
5Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
6Center for Diabetes Research, Gentofte University Hospital, Copenhagen, Denmark
7Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
8General Practice Research Unit, Department of Public Health, University of Southern Denmark, Odense, Denmark
9Department of Endocrinology, Odense University Hospital, Odense, Denmark
10Steno Diabetes Centre Copenhagen, Health Promotion, Gentofte, Denmark