Recent research published in The Lancet Diabetes & Endocrinology has found that individuals diagnosed with type 2 diabetes (T2D) at a younger age face a significantly higher mortality risk compared to those diagnosed later in life.
The study, titled “Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up,” investigates differences in mortality rates and complications between younger-onset and later-onset T2D patients. Traditionally seen as a condition affecting older adults, type 2 diabetes is increasingly recognized as a distinct non-autoimmune condition when it presents in younger individuals.
The research highlights concerns that early exposure to high blood sugar levels could lead to increased complications and a shorter life expectancy. Previous observations indicate that younger-onset T2D tends to progress more aggressively than later-onset forms of the disease, contributing to a heightened risk of complications and accelerated decline in pancreatic β-cell function.
This observational study analyzed data from the UK Prospective Diabetes Study, which spanned from 1977 to 2007. The UKPDS enrolled participants aged 25 to 65 who had newly diagnosed diabetes, categorizing them based on their fasting plasma glucose levels. Those with fasting plasma glucose between 6 mmol/L and 15 mmol/L were assigned to either a conventional glycemic control strategy—primarily dietary changes—or to an intensive strategy involving insulin or oral medications. Patients with fasting plasma glucose levels exceeding 15 mmol/L were treated intensively, while those below 6 mmol/L adhered to a diet regimen.
For this analysis, younger-onset T2D was defined as diagnosis before the age of 40, while later-onset T2D was classified as diagnosis at age 40 or older. The researchers assessed seven key outcomes: diabetes-related events, diabetes-related mortality, all-cause mortality, myocardial infarction, peripheral vascular disease, stroke, and microvascular disease. They calculated both absolute and adjusted incidence risks for each outcome over the follow-up period, using Poisson regression to control for factors such as body mass index (BMI), sex, ethnicity, and other health metrics.
The study included 4,550 UKPDS participants who did not have diabetes-related autoantibodies. Among these, 429 individuals had younger-onset T2D, with an average diagnosis age of 35.1 years, while the remaining participants had an average diagnosis age of 53.8 years for later-onset T2D. At the time of diagnosis, those with younger-onset T2D were predominantly of Indian or Asian descent, had a higher average BMI, elevated fasting triglyceride levels, and lower HbA1c levels compared to their later-onset counterparts.
Over a median follow-up of 18 years for younger-onset T2D and 17.4 years for later-onset T2D, 47.1% and 73.2% of participants, respectively, experienced diabetes-related complications. Although younger-onset T2D participants initially exhibited a lower overall mortality rate, they demonstrated a higher excess mortality rate associated with T2D compared to the general population. Notably, the standardized mortality ratios (SMRs) showed that the youngest age group (24–35 years) experienced the highest SMR, which decreased with increasing age at diagnosis.
Improvements in fasting plasma glucose, BMI, HbA1c, and estimated β-cell function were observed across all age groups one year after diagnosis. However, in the first two decades following diagnosis, younger-onset T2D subjects exhibited rising levels of fasting plasma glucose, BMI, insulin resistance, and HbA1c. Moreover, β-cell function, which was initially higher in younger-onset patients, declined more sharply during the first ten years post-diagnosis.
In total, 75.1% of younger-onset and 85.2% of later-onset T2D participants were assigned to glycemic control strategies, with no significant differences in treatment outcomes between the two groups. However, those receiving insulin or sulfonylureas saw a significant reduction in risks related to all-cause mortality and diabetes complications, a benefit that was not observed in the younger-onset T2D group.
The study’s findings underscore that younger-onset T2D is associated with an increased risk of diabetes-related complications, suboptimal glycemic control, and excess mortality compared to later-onset T2D. These results suggest a pressing need for targeted healthcare services and interventions aimed at identifying and managing younger individuals with type 2 diabetes effectively.
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