Early age of type 2 diabetes diagnosis tied to poorer health

Being diagnosed with type 2 diabetes at a young age comes with more serious complications and higher rates of death than being diagnosed later in life, according to a new analysis.

Adults diagnosed between ages 15 and 30 had more severe nerve damage and signs of early kidney disease than those who had lived with the disease for a similar amount of time but were diagnosed between ages 40 and 50, researchers found. The younger group also had much higher risk of death than peers without diabetes.

"Firstly, we know that it takes many years to develop complications in diabetes," said senior author Jencia Wong of the Diabetes Center at Royal Prince Alfred Hospital in Sydney and the University of Sydney in Australia. "Of course having type 2 diabetes at a younger age equates to a higher lifetime risk given the projected length of exposure to high glucose and other risk factors."

Younger people may also have something in their physiology, inherited or not, that makes them more susceptible to the damaging effects of high blood sugar and other risk factors, Wong added.

"It may also be that the burden of diabetes at this time of life, coinciding with the challenges of adolescence, with caring for a young family or starting a career, with economic or mental health stressors, makes good metabolic control and self-care all the more challenging," she told Reuters Health by email.

The researchers analyzed data on 354 patients diagnosed with type 2 diabetes in adolescence and early adulthood, and 1,062 patients with more typical onset between ages 40 and 50. The study team used the Royal Prince Alfred Hospital Diabetes electronic database linked to the Australian National Death Index to track complications and deaths related to diabetes.

Patients diagnosed at a young age were matched to patients diagnosed at an older age who had had diabetes for a similar length of time.

Both groups tended to have similar rates of metabolic syndrome, a constellation of traits including abdominal obesity, high cholesterol and high blood pressure that raise the risk of heart disease. But those diagnosed at an older age were more likely to have been treated for their high blood pressure and cholesterol.

Those diagnosed at a younger age had more severe albuminuria, high levels of protein in the urine that are an early sign of diabetic kidney disease, according to the U.S. National Kidney Foundation. The younger people also had more severe nerve damage than those diagnosed at an older age, the researchers report in Diabetes Care.

On average, the patients were followed for 10 years until death or the end of the study. The overall risk of death was lower for those diagnosed younger, but diabetes had a stronger effect on that risk for the younger group. Relative to the general population in their own age group, the people diagnosed with type 2 diabetes young had more than three times higher death rates. That rose to six times higher when they were in early middle age.

People first diagnosed in middle age had death rates comparable to the general population in their own age group, in contrast.

"Elevated glucose in an older person may not add all that much in terms of long term risk, over and above the impact of age itself," Wong said.

The impact of type 2 diabetes on younger people should not be underestimated, she said.

"Our hope is that this research will serve to highlight that type 2 diabetes in the young is a serious condition which should be recognized by treating clinicians as such and be managed accordingly," she said.

Doctors may be reluctant to give more than just lifestyle advice to young people with type 2 diabetes, she said.

"Extrapolating from studies in older type 2 diabetes, excellent metabolic control and aggressive vascular risk factor management early in the course of diabetes would be in order here," Wong said. "Studies examining how to best manage young onset type 2 diabetes are underway and will shed greater light on this area."

Continuing to tackle childhood obesity, one of the main modifiable risk factors for diabetes, should also be a priority for preventing diabetes altogether, she said.