番茄社区

Younger age at diabetes diagnosis portended worse outcomes later in life, a meta-analysis found.

In data covering some 1.3 million individuals, each additional year of age at initial diagnosis with type 2 diabetes was tied to 4% lower risk for all-cause mortality (odds ratio 0.96, 95% CI 0.94-0.99, P<0.001) after adjustment for current age, reported Natalie Nanayakkara, MBBS, of Monash University in Australia, and colleagues in .

The benefits of staving off diabetes didn't end there, as each year later a person developed diabetes was also tied to a 3% (OR 0.97, 95% CI 0.96-0.98, P<0.001) and 5% (OR 0.95, 95% CI 0.94-0.96, P<0.001) lowered risk for macrovascular disease and microvascular disease, respectively.

"Early and sustained interventions to improve blood glucose levels and cardiovascular risk profiles in those with established type 2 diabetes and interventions to delay the onset of type 2 diabetes in those at high risk are essential to reduce ill health and mortality associated with this condition," Nanayakkara pointed out in a statement.

She added that for people who have received a diabetes diagnosis early in life, achieving good blood sugar control as soon as possible is vital to avoid such complications. Additionally, getting good control on other risk factors like a healthy BMI and blood pressure are also extremely important for these patients.

To explain the difference between absolute versus lifetime risks further, the researchers wrote: "a person diagnosed with type 2 diabetes at age 30 years would have a lower absolute risk of complications compared with a person diagnosed at age 50 years but by the time they both reach age 60 years the person diagnosed at a younger age would have a higher relative and absolute risk due to the effects of aging, compounded by the effects of longer diabetes duration."

Nanayakkara added that this absolute versus lifetime risk difference in people with type 2 diabetes should be recognized in diabetes management guidelines, along with an increased focus on screening programs for older folks and preventive programs for younger adults.

The analysis pooled data from 26 observational studies that included people from 30 countries across Asia, Europe, and North America. Macrovascular diseases included a composite of coronary heart disease, cerebrovascular disease, and peripheral vascular disease, while microvascular disease was a composite of retinopathy, nephropathy, and neuropathy.

When broken down by specific macrovascular and microvascular complications, each 1-year increase in age at diabetes diagnosis was associated with a risk reduction in the following conditions (P<0.001 for all):

• Coronary heart disease: OR 0.98 (95% CI 0.97-0.98)
• Cerebrovascular disease: OR 0.98 (95% CI 0.97-0.99)
• Peripheral vascular disease: OR 0.97 (95% CI 0.96-0.99)
• Retinopathy: OR 0.92 (95% CI 0.90-0.95)
• Nephropathy: OR 0.94 (95% CI 0.92-0.96)
• Neuropathy: OR 0.95 (95% CI 0.94-0.96)

"[T]he data suggest that younger people with type 2 diabetes receive suboptimal medical attention, potentially due in part to an absence of clinical guidelines targeted to younger people with type 2 diabetes and possibly the underestimation of risks of complications in these individuals," the researchers concluded.

Comment