High mental illness burden in young-onset type 2 diabetes
medwireNews: Over a third of time spent in hospital before the age of 40 years by patients who develop type 2 diabetes by this age is due to mental illness, report researchers.
Specifically, Juliana Chan (The Chinese University of Hong Kong) and team found that 36.8% of bed–days before the age of 40 years were due to mental illness, with most of these accounted for by psychotic conditions (55.1%) and mood disorders (31.4%).
“We found a previously unknown burden of serious mental illness before age 40 years, and understanding its causes is imperative to improving mental health care in young adults,” they write in the Annals of Internal Medicine.
The association was not explained by the use of atypical antipsychotics increasing the risk for diabetes, the team notes.
Among 422,908 people (46.3% women) with type 2 diabetes from a population-based cohort and 20,886 from a diabetes registry, the researchers found hospitalization rates in those with a young onset age “far exceeding age-specific rates for the general population.”
At the age of 20–24 years, people who already had diabetes had a hospitalization rate of around 1000 bed–days per 1000 patient–years, which was approximately fourfold higher than the rate among the general population of Hong Kong at that age.
For patients with young-onset diabetes (onset age <40 years), the hospitalization rate remained at between 1000 and 2000 bed–days per 1000 patient–years until an attained age of 55 years, after which it climbed to a maximum of more than 6000 bed–days per 1000 patient–years for the 70–74 years age group. At this older age, the rate in the general Hong Kong population was less than 2500 bed–days per 1000 patient–years.
Patients whose diabetes was diagnosed at older ages had intermediate results – with fewer days in hospital than those whose diabetes was diagnosed when they were younger than 40 years but more relative to the general population.
After accounting for multiple risk factors, developing diabetes at 34, as opposed to 54, years of age was associated with a significantly increased risk for hospitalization at age 60 years due to diabetes and to renal and cardiovascular causes, with hazard ratios ranging from 1.9 to 4.1, but not because of infection.
“These differences are much higher than previously known because earlier analyses did not capture multiple admissions,” say Chan and team.
They add: “These increased rates reveal the disproportionate effects of increased disease duration and glycemic burden in [young-onset diabetes] and challenge the perception that youth protects against hospitalization.”
The researchers calculated that by the age of 75 years, someone who had diabetes diagnosed at the age of 33 years would have spent a cumulative 97 days in hospital for any reason, compared with 59 and 29 days for people whose diabetes was diagnosed at a respective 50 and 65 years of age.
However, they also calculated that intensive risk factor management in a person whose diabetes was diagnosed at the age of 33 years would reduce their cumulative days in hospital from 97 to 65, although they stress that randomized trials are needed to confirm this.
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