Diagnosed Type 2 Diabetes Before Age 40 Linked With Increased Mortality

Diagnosed type 2 diabetes under the age of 40 is associated with an increased risk for death from cardiovascular disease, new study results published in Circulation suggest.

“Our study shows the differences in excess diabetes risk are tied to how old the person is when they are diagnosed with type 2 diabetes,” said Naveed Sattar, MD, PhD, lead author and professor of Metabolic Medicine at the University of Glasgow in the United Kingdom, in a press release.

The researchers used data from the Swedish National Diabetes Registry. The study population included 318,083 patients with type 2 diabetes and about 1,575,108 matched control patients. The researchers followed deaths from heart disease from the years 1998 to 2014. They used Cox proportional hazards models for those without prior cardiovascular disease, repeating the process for the full study cohort. The study outcomes of interest included total mortality, cardiovascular mortality, noncardiovascular mortality, coronary heart disease, acute myocardial infarction, stroke, heart failure, and atrial fibrillation. There was a median follow-up period of 5.63 years.

Attenuated Effect with Age

According to the study results, patients with a diagnosis of type 2 diabetes before age 40 had the highest excess risk for most study outcomes compared to the controls (95% confidence intervals for all). This included for mortality (adjusted HR=2.05; 1.81 to 2.33), cardiovascular-related mortality (1.95; 1.68 to 2.25) , non-cardiovascular-related morality (1.95;  1.68 to 2.25), heart failure (4.77; 3.86 to 5.89), and coronary heart disease (4.33; 3.82 to 4.91). The risk was attenuated as the decade in which the diagnosis was delivered increased. A diagnosis of type 2 diabetes beyond 80 years of age was essentially equivalent of that seen in controls.

“This suggests we need to be more aggressive in controlling risk factors in younger type 2 diabetes populations and especially in women,” Sattar said. “And, far less effort and resources could be spent screening people 80 and older for type 2 diabetes unless symptoms are present. Furthermore, our work could also be used to encourage middle-aged people at elevated diabetes risk to adopt lifestyle changes to delay their diabetes by several years.”

According to the press release, this study was the first “to compare the excess risks of dying from or developing cardiovascular disease in people diagnosed with type 2 diabetes and to adjust the risk for such outcomes given how long a person has had diabetes.”