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Young adults with type 2 diabetes at heightened risk of CVD, premature death

By Nicole MacKee
People diagnosed with type 2 diabetes before age 40 years are at higher risk of cardio­ vascular disease and premature death than those diagnosed at an older age, say Swedish researchers.

In a registry study published in Circulation, researchers assessed 318,083 patients in the Swedish National Diabetes Registry and 1.6 million matched controls. After a median follow up of 2.5 years, the researchers found that people who were diagnosed with type 2 diabetes when they were younger than 40 years had the highest excess risk, relative to controls, of total mortality (adjusted hazard ratio [aHR], 2.05), cardiovascular-related mortality (aHR, 2.72), noncardiovascular mortality (aHR, 1.95), heart failure (aHR, 4.77) and coronary heart disease (aHR, 4.33).

The researchers found that the risk of cardiovascular complications and all-cause mortality reduced with advancing age at diagnosis of diabetes, and by age 80 years the risks had largely dissipated.

They reported that adolescents who were diagnosed with type 2 diabetes may have their life cut short by more than a decade, whereas those diagnosed in their 80s were shown to have the same life expectancy as the control group.

Professor Mark Cooper, Head of the Dia­betes Department in Monash University’s Central Clinical School, Melbourne, said in the worldwide epidemic of diabetes, two distinct groups of patients had emerged: those who developed type 2 diabetes after 80 years and those who developed the disease in their teens, 20s and 30s.

He said the younger cohort was developing a more aggressive form of type 2 diabetes and, because complications were duration dependent, they were developing complications such as cardiovascular disease at a younger age.

‘We have to aggressively treat these patients, but they are difficult to treat because the usual drugs don’t work as well in these people,’ Pro­fessor Cooper said. He added risk factors such as weight gain, high blood pressure and high cholesterol and triglyceride levels all needed to be treated aggressively in these people.

Professor Cooper said prevention was crucial but challenging in this group.

‘People are living in this modern, Western environment, with reduced levels of exercise, sedentary behaviour, increased food intake and a higher intake of fat and refined carbo­hydrates, so they are developing this early­ onset type 2 diabetes,’ he said.

Professor Cooper said the risk was pro­nounced in Indigenous Australians, who were developing diabetes at young ages and were at a very high risk of complications.

The author of the Circulation study concluded that elderly people who develop type 2 diabe­tes may not require aggressive treatment.
Circulation 2019; 139: 00-00. doi: 10.1161/CIRCULATIONAHA.118.037885.