Age-specific risk profiles may be needed for effective diabetes prevention
medwireNews: The influence metabolic factors have on type 2 diabetes risk falls as people get older, whereas lifestyle factors convey a greater risk with age, show data from a large, prospective cohort in China.
Therefore, “[p]rioritising age-specific risk profiles for diabetes is essential for precise and efficient prevention and control of diabetes, especially in China—a country that is facing formidable health challenges related to non-communicable chronic diseases that are potentially exacerbated by an ageing population,” write Weiqing Wang (Shanghai Jiao Tong University School of Medicine) and co-authors in The Lancet Healthy Longevity.
They found that 6171 (6.6%) of 93,781 China Cardiometabolic Disease and Cancer Cohort Study participants without diabetes at baseline developed the condition during a median 3.1 years of follow-up. Incidence increased with age, from 5.1% among participants aged 40 to 54 years to 7.3%, 9.2%, and 10.0% among those aged 55 to 64 years, 65 to 74 years, and 75 years and older, respectively.
Analysis of metabolic, lifestyle, and socioeconomic risk factors revealed that metabolic risk factors were most strongly associated with incident diabetes overall. Prediabetes conferred the greatest population-attributable risk percentage (PAR%) at 56.0%, followed by hypertension (20.1%), obesity (12.4%), less education (11.8%), insulin resistance (11.7%), dyslipidemia (6.8%), unhealthy sleep (5.0%), unhealthy diet (4.9%), physical inactivity (1.8%), and alcohol consumption (1.4%).
However, the impact these modifiable factors had on diabetes incidence varied with age. Specifically, metabolic factors accounted for 73.8% of diabetes incidence among individuals aged 40 to 54 years and 55 to 64 years, falling to 70.0% in those aged 65 to 74 years and 65.5% among the oldest participants.
Of note, the risk attributable to prediabetes fell from 56.6% to 47.4% across the age groups, whereas that for hypertension increased from 16.8% to 28.6%. For obesity and dyslipidemia, the PAR% was zero by age 75 years, compared with 15.9% and 8.7%, respectively, among the youngest participants.
In contrast to metabolic factors, the overall impact of lifestyle factors on diabetes incidence increased more than threefold with age, from 9.9% to 29.7% in those aged 40 to 54 years and 75 years and older, respectively. The greatest increase was for unhealthy sleep (<6 or >8 hours per day), where the PAR% was 1.5% in the youngest participants and 17.0% in the oldest.
Socioeconomic risk factors had the least impact on diabetes incidence, with the PAR% ranging from 7.1% to 14.7% in participants younger than 75 years but conferring no excess risk in older participants.
Wang et al conclude that their “findings lend credence to the emerging recognition that risk factors for diabetes derived from younger adults might not be applicable to older populations.”
In an accompanying comment, Ruoling Chen, from the University of Wolverhampton in the UK, says: “This study shows the importance of prioritising age-specific risk profiles in different age groups (≥40 years) and the findings have implications for prevention and management of diabetes in China.”
He suggests: “We should pay more attention to modification of lifestyle factors, including increasing fruit intake and improving unhealthy sleeping patterns in people older than 65 years, and controlling obesity and dyslipidaemia in people younger than 75 years to reduce the risk and burden of diabetes in China.”
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