Younger age of diabetes diagnosis linked to greater rates of cardiovascular outcomes, mortality

People diagnosed with diabetes at the younger end of middle age (50 to 59) have significantly higher risks of subsequent incident heart disease, stroke, disability, cognitive impairment and mortality compared to non-diabetics. But oddly, when compared to people diagnosed with diabetes in mid-life, the increase of incidence of comorbidities decreases with older age of diagnosis. This comes from an analysis of 23-years worth of data of participants in the U.S. Health and Retirement Study (HRS). The HRS is, a cohort study, a population-based, biennial longitudinal health interview survey of older adults. The study used data from the 1995 through 2018 waves. Details were published in JAMA Network Open. Read: Is type 2 diabetes becoming an obsolete diagnosis? “It’s possible that adults who are younger at diagnosis may have a more aggressive form of diabetes, poorer glycemic control and other factors,” said study senior author Dr. Judy Zhong. She is a professor of population health and environmental medicine at New York University. Several studies have suggested that earlier diagnosis of diabetes is associated with an increased risk of cardiovascular health outcomes and mortality, compared with those who are diagnosed even later in life. The study included 36,060 adults aged 50 years or older who did not have diabetes when they initially enrolled. At the time of analysis during 2021 and 2022, a total of 7,739 participants reported they had developed diabetes at some point after enrolling in the HRS. They consisted of 4,267 (55.1%) women; 3,472 (44.9%) men and had a mean age at diagnosis of 67.42 years. By age, among those who developed diabetes, 1,866 reported receiving their diagnosis when they were 50 to 59 years of age; 2,834, at 60 to 69 years of age; and 3,039, at 70 years or older. The remaining 28,321 participants who were used as age and demographic-factors matched controls reported no diabetes. The researchers then investigated five diabetes-related outcomes: heart disease, stroke, disability, cognitive impairment, and mortality. Overall, the older diabetic group had higher rates of the investigated comorbidities at their time of diagnosis, which was to be expected with increased age, Dr. Zhong said. However, things got more interesting when diabetics were compared to aged-matched non-diabetics who did not have diabetes. Here, the subsequent incidence of comorbidities such as heart disease, stroke, cognitive impairment and death was much higher in the 50 to 59 age group than in the matched controls of the same age, but the gap in incidence became narrower with increased age of diagnosis. For example, in the 50 to 59 age-of-diagnosis groups stroke occurred in 7.37% (1,412) of controls compared to 12.51% (1,412) of diabetics. In the 60 to 69 age-of-diagnosis group, 9.36% (2,142) of diabetics had stroke compared to 13% (2142) of controls. And in the 70 and over age-of-diagnosis group, stroke occurred in 17.77% (1,944) of controls and 19.3% (1,944) of the diabetics. While stroke, heart disease and other conditions become more common with older age, the ratio between diabetics and non-diabetics was higher with earlier diagnosis of diabetes and decreased with advancing age of diagnosis, the study said. “We provide evidence of the differential association of diabetes with incident distal outcomes across varying ages at diabetes diagnosis while accounting for diabetes duration. Our use of (a non-diabetic control) group helped us separate the association of diabetes with these outcomes from the association with increasing age,” the study said. The mechanisms that link earlier diabetes diagnosis to worse outcomes are not completely understood, Dr. Zhong said. It’s possible the younger adults have worse glycemic control, beta cell dysfunction, insulin insufficiency, and insulin resistance. But the implications are that younger adult diabetics may need to be treated differently than those who are diagnosed later on. When asked for a reaction to the findings, spokespeople from the Diabetes Canada were not available. The Diabetes Canada Clinical Practice Guidelines recommend that adults age 40 years or over who at risk for type 2 diabetes (T2D) should be tested at least every three years. Those with increased risk factors for T2D should be tested more frequently or start regular screening earlier. Some of the risk factors listed include: family history of diabetes; being a member of a high-risk population; history of prediabetes or gestational diabetes; and being overweight. In a chapter relating to older patients with diabetes, the guidelines state: “Diabetes in older people is distinct from diabetes in younger people and the approach to therapy should be different. This is especially true in those who have functional dependence, frailty, dementia or who are at end of life.” It adds: “No two older people are alike and every older person with diabetes needs a customized diabetes care plan.”

Younger age of diabetes diagnosis linked to greater rates of cardiovascular outcomes, mortality

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