medwireNews: Analysis of the Health and Retirement Study indicates that the adverse effects of earlier age of type 2 diabetes onset are also evident in an older population.
Indeed, if patients did not develop diabetes until they were older than 70 years its presence had no effect on their risk for developing cardiovascular disease (CVD), stroke, cognitive impairment, or disability.
The findings are in line with other recent research in adult populations, and with the TODAY study, which found a higher failure rate for metformin in youth with type 2 diabetes than is commonly seen in adults.
These latest results, reported at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA, this week, were obtained using data from 25,142 survey participants who were at least 50 years old and did not have diabetes at baseline. Participants who developed diabetes during follow-up were matched by the propensity to do so with participants who did not, based on age, sex, race, marital status, BMI, and net worth.
In contrast to the oldest group, the presence of diabetes in younger patients was associated with an increased risk for adverse outcomes. For the disability outcome, for example, the higher incidence in people with versus those without diabetes became significant from 10 years’ diabetes duration among those aged 50–59 years and from 12 years’ duration among those aged 60–69 years.
Patients in the youngest diabetes onset age group had significantly increased rates of CVD, stroke, disability, and mortality, relative to people who did not develop diabetes, at incidence rate ratios (IRRs) of 1.5, 1.6, 1.7, and 1.7, respectively, but diabetes did not affect their risk for cognitive impairment. Patients who developed diabetes between the ages of 60 and 69 years had a significantly raised IRR for CVD, of 1.2, but not for other outcomes.
In a multivariate competing risks model, all outcomes including cognitive impairment were significantly more likely in patients with the youngest age at diabetes onset versus those without diabetes, CVD risk was increased in the 60–69 years onset age group, and mortality risk was increased for all age groups.
“Our findings reinforce the idea of clinical heterogeneity in diabetes and the focus to improve diabetes management, especially at that younger age range, that is, in middle-aged adults,” said presenter Christine Cigolle (University of Michigan, Ann Arbor, USA).
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