Type 2 Diabetes in Youth Is Especially Unhealthy: Study
The earlier in life type 2 diabetes arises, the deadlier it is, a new analysis finds.
The study, which pooled the results of 26 previous ones, revealed a clear pattern: The younger people were when they developed type 2 diabetes, the greater their risk of complications like heart disease and stroke.
For each year type 2 diabetes was delayed, the risk of blood vessel diseases fell by 3% to 5%.
Younger patients were also at risk of premature death: Overall, for every additional year in age at diagnosis, the odds of dying during the study period declined by 4%.
Experts said the findings, published online Dec. 14 in the journal Diabetologia, are not surprising: The longer a person lives with diabetes, the more time there is for complications to accumulate.
Still, the results probably run counter to what many people would expect, said Dr. Jeffrey Mechanick, director of the Center for Cardiovascular Health at Mount Sinai Heart, in New York City.
In general, older adults face more complications from diseases than younger people who are in relatively better shape, said Mechanick, who reviewed the findings.
"But in the setting of type 2 diabetes," he said, "it's different."
Type 2 diabetes arises when the body becomes resistant to the effects of the hormone insulin, causing blood sugar levels to soar. Over time, both insulin resistance and chronically high blood sugar can lead to a range of complications, including damage to the blood vessels.
"It's not surprising that the earlier you see insulin resistance and (high blood sugar) begin, the more time there is for these sinister events to take place," Mechanick said.
In the United States, more than 34 million people have diabetes, and the vast majority have type 2, according to the American Diabetes Association.
At one time, type 2 diabetes was largely a disease of older adults. But with the ever-growing prevalence of obesity -- a major risk factor for type 2 diabetes -- the disease is increasingly being diagnosed in younger adults, and even in teenagers and children.
Yet younger patients tend to underestimate their risk of complications, according to Dr. Joanna Mitri. She's an endocrinologist at Joslin Diabetes Center in Boston, and an instructor at Harvard Medical School.
"It's important that young people with type 2 diabetes follow up regularly with their providers to optimize their cardiovascular risk factors," said Mitri, who was not involved in the study.
That, she added, means not only controlling blood sugar, but also blood pressure and cholesterol -- and losing weight when needed.
Dr. Natalie Nanayakkara, an endocrinologist at Monash University in Melbourne, Australia, led the study.
"The effects of both aging and disease duration may be additive," she said, "resulting in premature complications and death in people diagnosed with type 2 diabetes at a younger age."
Nanayakkara agreed that younger patients need to get all of their cardiovascular risk factors under control for the long haul. She also said providers need to figure out better ways to help them do that.
For the analysis, her team combined the results of 26 studies involving a total of more than 1.3 million people from 30 countries. Many of the studies followed people for a decade or more, with the average age of participants ranging from 22 to 67 at the outset.
Overall, the older people were at their diabetes diagnosis, the better, the findings showed.
Their risk of diseases connected to blood vessel damage declined by 3% to 5% for each one-year increase in age at diagnosis. That included such serious conditions as heart disease, stroke and the eye disease retinopathy.
Mechanick agreed that younger patients with diabetes can change that trajectory by getting their blood sugar, weight, blood pressure and cholesterol under control.
"But better yet," he said, "let's create a healthier environment for children."
Type 2 diabetes exists on a continuum, Mechanick said. And when it's diagnosed in younger adults, the disease is often associated with childhood obesity, as well as diet and exercise habits formed early in life.
Children need opportunities to play and be active, Mechanick said, as well as access to healthy foods, at school and at home.
He noted, though, that older adults who develop diabetes are not off the hook. Anyone with the disease can develop complications, Mechanick said, and all patients need to use diet, exercise and medications to lower those risks.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on type 2 diabetes.
SOURCES: Natalie Nanayakkara, MBBS, PhD, endocrinologist, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Jeffrey Mechanick, MD, director, Center for Cardiovascular Health at Mount Sinai Heart, and director, metabolic support, division of endocrinology, diabetes and bone disease, Icahn School of Medicine at Mount Sinai, New York City; Joanna Mitri, MD, MS, endocrinologist, Joslin Diabetes Center, and instructor, Harvard Medical School, Boston; Diabetologia, Dec. 14, 2020, online
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