T2D Diagnosis Before 40 Linked to More Than 5-fold Increase in Risk of All-Cause and Cardiovascular Mortality

New research is underlining the impact of youth onset type 2 diabetes on cardiovascular disease risk later in life.

A study comparing more than 600,000 patients with type 2 diabetes matched in a 2:1 ratio to more than 1.2 million without diabetes, results of the study provide insight into the risk of developing cardiovascular disease and mortality based on age at diagnosis, with results pointing to a more than 5-fold increase in risk of both all-cause and cardiovascular mortality for those diagnosed prior to 40 years of age compared to their counterparts without type 2 diabetes.

“In this large, population-based cohort study, being younger at the time of T2D diagnosis was associated with a higher relative risk of death and cardiovascular disease complications compared to those in the same group without diabetes”, said study investigator Seong Bin Hong, MD, PhD from Inha University School of Medicine, South Korea, in a statement. “Caring for young people with diabetes, which has traditionally focused on type 1 diabetes, should place more emphasis on type 2 diabetes. What’s more, effective health-care policies around screening, early diagnosis and treatment will help to combat the future rise of cardiovascular disease in this increasingly common young-onset, high-risk population.”

Supported by a grant from Inha University, Bin Hong and a team of colleagues from the university conducted the present study with the intent of assessing the association between mortality and cardiovascular outcomes based on age at diagnosis of type 2 diabetes relative to controls without type 2 diabetes. With this in mind, investigators designed their endeavor as a population cohort study using data obtained from the Korean National Health Insurance Service database for patients with newly diagnosed type 2 diabetes from 2012-2014.

Using the database, investigators identified 634,350 people with type 2 diabetes for inclusion in their analyses. For the purpose of analysis, investigators randomly selected control subjects from the general population and matched these individuals in a 2:1 based age, sex, and previous history of CVD to those with type 2 diabetes using propensity score matching analyses. The primary outcomes of interest for the study were all-cause mortality, cardiovascular mortality, coronary heart disease (CHD), acute myocardial infarction (AMI), stroke, hospitalization for heart failure, and 3-point major adverse cardiovascular events (MACE). Investigators pointed out follow-up for these events occurred until 2019 and primary analyses were conducted using Cox proportional hazards models in those with no previous cardiovascular disease and repeated the analysis in the entire cohort.

Over a mean follow-up of 5.7 years, 40% of those with type 2 diabetes and 23% of controls experienced a primary outcome event. Upon analysis, results indicated those diagnosed with type 2 diabetes at 40 years of age or younger had the greatest excess risk for most [primary outcomes compared to the controls, with a more than 5-fold increase in risk observed for all-cause mortality (HR, 6.08 [95% Ci, 5.50-6.72]), cardiovascular mortality (HR, 5.53 [95% CI, 4.29-7.14]), hospitalization for heart failure (HR, 7.19 [95% CI, 6.72-7.60]), and CHD (HR, 5.10 [95% CI, 4.91-5.30]) in adjusted analyses. Further analysis suggested risks for all these events were attenuated progressively with each increasing decade at diagnostic age, but the apparent increase in risk as a result of type 2 diabetes was still significant. Investigators highlighted the risks for all-cause mortality (HR, 1.29 [95% CI, 1.21-1.37]), cardiovascular mortality (HR, 1.32 [95% CI, 1.15-1.51]), hospitalization for heart failure (HR, 2.95 [95% CI, 2.54-3.42]), and CHD (HR, 3.66 [95% CI, 3.16-4.24]) were all notably lower among those aged 91 years or older at time of diagnosis compared to their counterparts without diabetes relative to the analyses comparing risk for those diagnosed at 40 years or younger.

“Our findings clearly highlight the serious health implications of developing type 2 diabetes at a young age and the importance of efforts to prevent diabetes in early life”, added lead investigator Da Hea Seo, from Inha University School of Medicine, South Korea.

This study, “Association between age at diagnosis of type 2 diabetes and cardiovascular and mortality risks: a nationwide population-based study,” was presented at EASD 2022.