Phd Candidate, Monash University
Despite shorter diabetes duration, younger age was associated with worse glycaemic control and poorer diabetes self-care practices among patients with type 2 diabetes. Targeted strategies are urgently required to optimise diabetes self-care practices and thereby improve glycaemic control.
Abstract: Little is known about the complication burden in later years among early onset type 2 diabetes mellitus (T2DM).To determine the magnitude of diabetes complications and adequacy of risk factor management and to test the hypothesis that diabetes duration is an important contributing factor to these complications.A cross-sectional study of secondary care diabetes population.Data on glycaemic control, cardiovascular risk factors (overweight/obesity, hypertension, dyslipidaemia), cardiovascular disease (CVD) and microvascular complications among those diagnosed before (early onset) and after (later onset) 40 years of age at different diabetes durations (<10, 10-20 and >20 years) were analysed.A total of 2733 subjects were identified, of which 527 had diabetes diagnosed below the age of 40 years. By the sixth decade of life, early onset cohort experienced high complication burden (CVD: 37.2%, retinopathy: 59.3% and neuropathy: 53.1%). Complication prevalence increased with diabetes duration but the increment rate was greater among early onset cohort. Compared with those diagnosed after 40, early onset cohort experienced similar burden of microvascular complications approximately 13-20 years earlier. Diabetes duration was a significant predictor for microvascular and CVD complications. Prevalence of CVD risk factors was high ( approximately 80-93%) regardless of the age of diagnosis and diabetes duration. Early onset subjects were more likely to have poorer glucose control ( approximately 70-78%), untreated hypertension (26.3%) and a substantial number did not receive statin treatment for primary prevention (34.8%).Early onset T2DM subjects are at substantial risk of developing diabetes complications in later years but at an earlier stage than later onset cohort and prolonged exposure to adverse diabetic milieu is an important contributing factor. Management of risk factors for diabetes complications was inadequate among early onset subjects.
Pub.: 08 Sep '09, Pinned: 25 Aug '17
Abstract: In the UK, the care of young people with diabetes has focused predominantly on type 1 diabetes (T1D). However, young-onset T2D has become increasingly prevalent. At present, it is unclear which type of diabetes represents the more adverse phenotype to develop complications. This study aims to determine the complication burden and its predictive factors in young-onset T2D compared with T1D.A cross-sectional study using a hospital diabetes register to identify patients with young-onset T2D and T1D. Young-onset T2D was defined as age of diagnosis below 40 years. The T1D cohort with a similar age of diagnosis was used as a comparator. Data from the last clinic visit was used for analysis. Clinical characteristics and diabetes complications were evaluated at diabetes durations <10, 10-20, and >20 years. Predictive factors for diabetes complications (age, sex, glycated hemoglobin, creatinine, diabetes duration, hypertension, dyslipidemia, and body mass index >25) were determined by logistic regression analysis.Data were collected on 1287 patients, of which 760 and 527 had T1D and T2D, respectively. In all diabetes durations, the T2D cohort had an older age of onset (p<0.0005) with a higher prevalence of obesity, hypertension, and dyslipidemia (all p<0.0005) while glycemic control was similar in both groups. Cardiovascular disease (p<0.005) and neuropathy (p<0.05) were more prevalent in the young-onset T2D cohort in all diabetes durations. There was no difference in retinopathy. Cardiovascular disease was predominantly due to ischemic heart disease. Stroke and peripheral vascular disease became significantly higher in T2D after 20 years duration. After controlling for traditional risk factors, young-onset T2D was an independent predictor for cardiovascular disease (p<0.005) and neuropathy (p<0.05) but not for retinopathy.Young-onset T2D is a more aggressive phenotype than T1D to develop diabetes complications, particularly for ischemic heart disease and neuropathy.
Pub.: 26 Feb '15, Pinned: 25 Aug '17
Abstract: Little is known about the burden of severe retinal disease between young‐onset type 2 (T2D) and type 1 diabetes (T1D). This study assessed the prevalence of significant retinopathy in young‐onset T2D vs. T1D and its predictive factors.This was a cross‐sectional study. Subjects with T1D and T2D diagnosed below age 40 were identified from diabetes eye screening register. Preproliferative, proliferative, maculopathy changes and/or previous laser photocoagulation treatment were considered to have significant retinopathy (SigDR).A total of 1306 subjects were identified, of whom 842 and 464 had T1D and T2D, respectively. The mean age of diagnosis was significantly lower in T1D subjects (T1D vs. T2D; 20.1 ± 10.3 vs. 32.1 ± 6.0 years, p < 0.0005). Although the T2D cohort had shorter diabetes duration (T1D vs. T2D; 20.8 ± 13.0 vs. 13.7 ± 9.0 years, p < 0.0005), the overall prevalence of SigDR was similar to T1D (T1D vs. T2D; 21.6 vs. 20.9%, p = NS). After adjusting for diabetes duration, the T2D cohort experienced significantly higher prevalence of this complication than T1D after 10 years duration. The age threshold beyond which the T2D cohort began to experience greater burden of SigDR was approximately 50 years. The prevalence of any retinopathy after 15 years duration was 75–80% for both young‐onset cohort. Risk factors for SigDR (older age, diabetes duration, systolic BP, HbA1c and creatinine) were similar in both young‐onset diabetes cohort with poor glycaemic control being the strongest variable. Lower age of T2D diagnosis was not a predictive factor.Irrespective of diabetes type, subjects with young‐onset diabetes possessed high lifetime risk for retinopathy. However, young‐onset T2D cohort was more susceptible to severe retinal disease with substantial burden of this complication by the fifth decade of life.
Pub.: 29 Mar '16, Pinned: 25 Aug '17