By Kathryn Doyle
(Reuters 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 recognised 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.
SOURCE: http://bit.ly/1PFzlOU Diabetes Care, online March
16, 2016.
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