Temporal Trend in Young-Onset Type 2 Diabetes—Macrovascular and Mortality Risk: Study of U.K. Primary Care Electronic Medical Records
Digsu N. Koye, Joanna Ling, John Dibato, Kamlesh Khunti, Olga Montvida, Sanjoy K. Paul
Abstract
OBJECTIVE To evaluate temporal prevalence trend, cardiometabolic risk factors, and the risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality (ACM) in incident young- and usual-onset type 2 diabetes. RESEARCH DESIGN AND METHODS From the U.K. primary care database, 370,854 people with a new diagnosis of type 2 diabetes from 2000 to 2017 were identified. Analyses were conducted by age- group (18–39, 40–49, 50–59, 60–69, 70–79 years) and high-/low-risk status without history of ASCVD at diagnosis, with subjects with two or more of current smoking, high systolic blood pressure, high LDL cholesterol (LDL-C), or chronic kidney disease classified as high risk. RESULTS The proportion of people aged <50 years at diagnosis increased during 2000–2010 and then stabilized. The incidence rates of ASCVD and ACM declined in people aged ≥50 years but did not decrease in people <50 years. Compared with people aged ≥50 years, those aged 18–39 years at diagnosis had a higher proportion of obesity (71% obese) and higher HbA1c (8.6%), and 71% had high LDL-C, while only 18% were on cardioprotective therapy. Although 2% in this age-group had ASCVD at diagnosis, 23% were identified as high risk. In the 18–39-year age-group, the adjusted average years to ASCVD/ACM in high-risk individuals (9.1 years [95% CI 8.2–10.0]/9.3 years [8.1–10.4]) were similar to the years in those with low risk (10.0 years [9.5–10.5]/10.5 years [9.7–11.2]). However, individuals aged ≥50 years with high risk were likely to experience an ASCVD event 1.5–2 years earlier and death 1.1–1.5 years earlier compared with low-risk groups (P < 0.01). CONCLUSIONS Unlike usual-onset, young-onset type 2 diabetes has similar cardiovascular and mortality risk irrespective of cardiometabolic risk factor status at diagnosis. The guidelines on the management of young-onset type 2 diabetes for intensive risk factor management and cardioprotective therapies need to be urgently reevaluated through prospective studies.