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03-17-2020 | Primary care | News

Initial glycemic control poor after type 2 diabetes diagnosis in younger adults

Anita Chakraverty

medwireNews: Adults who develop type 2 diabetes at a younger age have a much lower likelihood of achieving glycemic control a year after diagnosis than those who develop it in middle age, research indicates.

Among 32,137 individuals identified with incident diabetes in a US healthcare system, those aged 21 to 44 years had a 30% lower likelihood of achieving glycated hemoglobin (HbA1c) levels below 7% (<53 mmol/mol) than individuals aged 45 to 64 years, even after accounting for their significantly higher mean HbA1c levels at diagnosis and other factors.

The researchers suggest that differences in the way these groups make contact with their primary care provider (PCP) following diagnosis suggests traditional approaches for delivering care might not be meeting the needs of this younger age group.

“Adults with younger onset in our study were more active users of the online patient portal and had less in-person contact with their PCP during the year after their type 2 diabetes diagnosis,” they explain.

“These results suggest that technology-based tools may provide more optimal opportunities for PCP interaction and diabetes self-management support that fit better with younger adults’ schedules (i.e., not restricted to times during the workday).”

Anjali Gopalan (Kaiser Permanente Northern California, Oakland, USA) and colleagues studied electronic health records from individuals aged 21 to 64 years who had a diabetes-defining index HbA1c of at least 6.5% (≥48 mmol/mol) between 2010 and 2016 and received a clinical diabetes diagnosis within 3 months.

None of the study participants had prior evidence of diabetes and they had been members of the healthcare system for at least a year before the initial HbA1c test.

Overall, 26.4% of the group had younger-onset diabetes at age 21–44 years, while for 73.6% of the group diabetes was diagnosed in middle age (45–64 years). Initial mean HbA1c levels were significantly higher in the former than latter group, at 8.9% (74 mmol/mol) versus 8.4% (68 mmol/mol).

Individuals in the younger group were 18% less likely than their older peers to make in-person contact with their PCP, although they were as likely to make telephone contact.

And while those in the younger group had a 20% greater likelihood of starting metformin following diagnosis, they were 26% less likely to adhere to this medication.

Gopalan et al note that individuals in the younger group had a significantly higher initial mean BMI than the older group, at a corresponding 36.1 versus 33.4 kg/m2 and were also significantly more likely to have an index HbA1c of at least 10% (86 mmol/mol), at 31.9% versus 22.6%.

“Tailored treatment strategies that address the more severe hyperglycemia and obesity seen at diagnosis and the unique treatment barriers present among this higher-risk younger-onset population are needed in order to support timely achievement of recommended treatment goals that are associated with improved long-term outcomes,” they say.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Diabetes Care 2020; doi:10.2337/dc19-1380

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