Clinical research study
Premature Mortality and Comorbidities in Young-onset Diabetes: A 7-Year Prospective Analysis

https://doi.org/10.1016/j.amjmed.2014.03.018Get rights and content

Abstract

Background

There is an increasing prevalence of young-onset diabetes, especially in developing areas. We compared the clinical outcomes and predictors for cardiovascular-renal events between Chinese patients with type 2 diabetes with young- or late-onset of disease diagnosed before or after the age of 40 years, respectively.

Methods

The Hong Kong Diabetes Registry was established in 1995 as an ongoing quality improvement initiative with consecutive enrollment of diabetic patients from ambulatory settings for documentation of risk factors, microvascular and macrovascular complications, and clinical outcomes using a structured protocol.

Results

In 9509 Chinese patients with type 2 diabetes with a median (interquartile range) follow-up period of 7.5 (3.9-10.8) years, 21.3% (n = 2066) had young-onset diabetes. Despite 20 years difference in age, patients with young-onset diabetes (mean age, 41.3 years) had a similar or worse risk profile than those with late-onset disease (mean age, 61.9 years). Compared with the patients with late-onset diabetes, those with young-onset diabetes had lower rates of cardiovascular disease and chronic kidney disease for the same disease duration but a higher cumulative incidence of clinical events at any given age. With the use of stepwise Cox proportional hazard analysis, patients with young-onset diabetes had higher risks for cardiovascular and renal events when adjusted by age, but no difference in risks than in the patients with late-onset diabetes when further adjusted by disease duration.

Conclusions

Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration.

Section snippets

Patients

The Prince of Wales Hospital is the teaching hospital of the Chinese University of Hong Kong and serves a catchment of 1.2 million, representing one sixth of the population in Hong Kong. The Hong Kong Diabetes Registry, established since 1995 as a quality improvement program, consecutively enrolled patients who were referred to the hospital for comprehensive assessment of metabolic control and diabetes complications. Referral sources included regional public community clinics, hospital-based

Baseline Patient Characteristics

Among 10,129 enrolled patients, 374 with type 1 diabetes, 38 with unknown type of diabetes, and 211 with non-Chinese ethnicity were excluded. In the remaining 9506 patients with type 2 diabetes, 2066 (21.3%) were diagnosed before the age of 40 years: 87 (0.9%) before the age of 20 years, 392 (4.0%) between the age of 20 to 29 years, and 1587 (16.3%) between the age of 30 to 39 years. There was a female preponderance in the young-onset group who were more likely to have positive family history,

Discussion

Despite the increasing prevalence of young-onset type 2 diabetes worldwide,11 there are relatively few reports on the natural history of this form of diabetes.4, 5, 12, 13 To the best of our knowledge, this is the largest prospective cohort of patients with young-onset diabetes, which accounted for 20% of the entire cohort. Despite being younger by 20 years, the young-onset group had similar or worse risk profiles than the late-onset group. With a mean age of 40 years and mean disease duration

Conclusions

In this large prospective cohort, 1 in 5 patients had young-onset diabetes characterized by strong family history and suboptimal risk factor control. Given the long disease duration faced by these patients, their lifetime risk for complications becomes considerably higher than in the late-onset group given the same age. An integrated program combining detection, treatment, and prevention is urgently needed to monitor disease trend, improve care, and evaluate the cost-effectiveness of

Acknowledgments

The authors thank all the patients for being part of this prospective cohort. Special thanks are extended to our medical and nursing staff at the Chinese University of Hong Kong, Prince of Wales Hospital Diabetes and Endocrine Centre, an International Diabetes Federation Centre of Education.

References (31)

  • M.E. Pavkov et al.

    Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians

    JAMA

    (2006)
  • T.A. Hillier et al.

    Complications in young adults with early-onset type 2 diabetes: losing the relative protection of youth

    Diabetes Care

    (2003)
  • J.C.N. Chan et al.

    The complexity of vascular and non-vascular complications of diabetes: The Hong Kong Diabetes Registry

    Curr Cardiovasc Risk Rep

    (2011)
  • S.H. Song et al.

    Early onset type 2 diabetes mellitus: a harbinger for complications in later years – clinical observation from a secondary care cohort

    QJM

    (2009)
  • Y.C. Ma et al.

    Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease

    J Am Soc Nephrol

    (2006)
  • Cited by (0)

    Funding: The study is partially supported by the Hong Kong Foundation for Research and Development and Liao Wun Yuk Memorial Diabetes Research Fund of the Chinese University of Hong Kong.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

    View full text