Temporal trend in young-onset type 2 diabetes-macrovascular and mortality risk: Study of U.K. primary care electronic medical records

Abstract

OBJECTIVE To evaluate temporal prevalence trend, cardiometabolic risk factors, and the risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality (ACM) in incident young-and usual-onset type 2 diabetes. RESEARCH DESIGN AND METHODS From the U.K. primary care database, 370,854 people with a new diagnosis of type 2 diabetes from 2000 to 2017 were identified. Analyses were conducted by age-group (18–39, 40–49, 50–59, 60–69, 70–79 years) and high-/low-risk status without history of ASCVD at diagnosis, with subjects with two or more of current smoking, high systolic blood pressure, high LDL cholesterol (LDL-C), or chronic kidney disease classified as high risk. RESULTS The proportion of people aged <50 years at diagnosis increased during 2000–2010 and then stabilized. The incidence rates of ASCVD and ACM declined in people aged ≥50 years but did not decrease in people <50 years. Compared with people aged ≥50 years, those aged 18–39 years at diagnosis had a higher proportion of obesity (71% obese) and higher HbA1c (8.6%), and 71% had high LDL-C, while only 18% were on cardioprotective therapy. Although 2% in this age-group had ASCVD at diagnosis, 23% were identified as high risk. In the 18–39-year age-group, the adjusted average years to ASCVD/ACM in high-risk individuals (9.1 years [95% CI 8.2–10.0]/9.3 years [8.1–10.4]) were similar to the years in those with low risk (10.0 years [9.5–10.5]/10.5 years [9.7–11.2]). However, individuals aged ≥50 years with high risk were likely to experience an ASCVD event 1.5–2 years earlier and death 1.1–1.5 years earlier compared with low-risk groups (P < 0.01). CONCLUSIONS Unlike usual-onset, young-onset type 2 diabetes has similar cardiovascular and mortality risk irrespective of cardiometabolic risk factor status at diagnosis. The guidelines on the management of young-onset type 2 diabetes for intensive risk factor management and cardioprotective therapies need to be urgently reevaluated through prospective studies.