Longer duration of type 2 diabetes associated with higher mortality risk
medwireNews: Patients who are diagnosed with type 2 diabetes at a younger age have an elevated risk for all-cause and cardiovascular mortality than those with shorter duration of disease, researchers report.
“[F]or two men of the same age but 10 years’ difference in diabetes duration, the one with the earlier onset (and hence the longer duration of diabetes) has an approximately 30% and 60% greater risk of death from any cause and from CVD [cardiovascular disease], respectively, relative to the person with the shorter duration,” say Dianna Magliano (Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia) and co-authors.
The team analyzed data from 743,709 Australian type 2 diabetes patients with a median age of 58.6 years at diagnosis who were registered in the National Diabetes Services Scheme (NDSS), 115,363 of whom died over a median follow-up of 7.2 years.
They found that rates of death from any cause initially declined within the first 1–2 years of diabetes diagnosis, and then rose exponentially with increasing age. For patients of all ages, the risk for all-cause mortality was higher for those with a younger age at diagnosis – indicating longer diabetes duration – among both men and women.
And this increased risk was “primarily driven” by CVD mortality, report the researchers in Diabetologia.
Indeed, when mortality rate ratios were compared, each 10-year decrease in age at diagnosis of diabetes was associated with an approximately 1.2–1.3-fold increased risk for death from any cause, and around a 1.6-fold increased risk for CVD mortality.
Conversely, male and female patients who were diagnosed with diabetes at a younger age had a lower risk for overall cancer mortality, as well as death from lung cancer, compared with those diagnosed at an older age. Earlier onset of diabetes was also associated with a lower risk for colorectal cancer mortality, but only among women.
To explain these results, the researchers suggest: “It is possible that following a diagnosis of diabetes, people have more frequent contact with the healthcare system, which may increase the likelihood of any present but undiagnosed cancer being detected.”
Although the study was large and the findings are “likely to be generalisable to Western countries similar to Australia,” Magliano and team caution that the NDSS database did not include information on potentially confounding factors including smoking, BMI, glycemic control, and comorbidities.
Nonetheless, they conclude that “early and aggressive CVD risk factor management is warranted for individuals with young-onset type 2 diabetes.”
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