medwireNews: Research by the Emerging Risk Factors Collaboration shows that being diagnosed with type 2 diabetes at a younger age is associated with shorter life expectancy, with 3 to 4 years lost for every decade of earlier diagnosis.
The data show that “high priority should be given to developing and implementing interventions that prevent or delay the onset of the condition, especially as its prevalence among younger age groups is increasing globally,” write Emanuele Di Angelantonio (University of Cambridge, UK) and collaborators in The Lancet Diabetes & Endocrinology.
They add: “The evidence also highlights the need for intensive treatment of risk factors for premature mortality among young adults diagnosed with diabetes.”
The findings are based on an analysis of information from two large-scale data sources (Emerging Risk Factors Collaboration and UK Biobank) that cover multiple prospective cohorts from 19 high-income countries. A total of 1,515,718 participants (mean age 55 years, 54% women) with a median 12.5 years (23.1 million person–years) of follow-up were included.
Di Angelantonio and co-authors report that they observed “a steep linear dose–response association between earlier age at diagnosis of diabetes and higher risk of all-cause mortality.”
After adjustment for age and sex, the team found that individuals diagnosed with type 2 diabetes at 30–39 years of age were a significant 2.69 times more likely to die of any cause during follow-up than those without diabetes. Diabetes diagnosis at age 40–49 years was associated with a significant 2.26-fold increased risk for all-cause mortality, while the risk increases were a significant 1.84-, 1.57-, and 1.39-fold for participants diagnosed at 50–59 years, 60–69 years, and 70 years and older, respectively.
Additional adjustment for risk factors such as BMI, systolic blood pressure, and total cholesterol had minimal impact on the results, but the researchers note the associations were “attenuated substantially” after further adjustment for fasting glucose or glycated hemoglobin levels.
Di Angelantonio then estimated how many years of life people with diabetes might lose depending on their age at diagnosis. Using death rates from the USA, they calculated that an individual with diabetes surviving to 50 years would die an average of 14 years earlier than someone without diabetes if the diabetes diagnosis occurred at 30 years of age. If they were diagnosed age 40 years, they would die 10 years earlier than a person without diabetes, and 6 years earlier if diagnosed age 50 years.
Of note, the estimates were slightly higher for women (16, 11, and 7 years, respectively) than for men (14, 9, and 5 years, respectively).
Around 30–45% of the reduction in life expectancy was due to deaths from cardiovascular disease, with the remaining proportion largely attributed to respiratory, neurologic, or infectious disease, and external causes.
The results were similar when the researchers used European mortality data, with deaths occurring at an average of 13, 9, and 5 years earlier when individuals were diagnosed with diabetes at 30, 40, and 50 years of age, respectively.
In an accompanying editorial, Bruce Duncan and Maria Inês Schmidt, both from the Universidade Federal do Rio Grande do Sul in Porto Alegre, Brazil, say the data are “of concern” and suggest that young-onset diabetes, typically defined as onset before age 40 years, “can now also be characterised as a condition that significantly reduces life expectancy.”
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Lancet Diabetes Endocrinol 2023; doi:10.1016/S2213-8587(23)00223-1
Lancet Diabetes Endocrinol 2023; doi:10.1016/S2213-8587(23)00255-3