Health Talk | Early-onset type 2 diabetes linked to higher mortality risk

Individuals with younger-onset type 2 diabetes (T2D) have an almost four-fold relative increase in risk of death compared with the general population, according to an observational study recently published in The Lancet Diabetes & Endocrinology.

According to the researchers, the younger onset means the disease is diagnosed before age 40 years.

Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. In type 2 diabetes, there are primarily two problems. The pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into the cells. Cells respond poorly to insulin and take in less sugar.
The study that assessed whether complications and mortality rates differ for younger onset of type 2 diabetes compared with older age at diagnosis, also found that adults with a later-onset of the disease have a one-and-a-half-fold higher risk of death compared to the general population, but this was much lower than the increased risk of death in people with younger-onset of the disease.
According to the data highlighted in the paper, over the past 30 years, the number of young adults diagnosed with type 2 diabetes has increased markedly worldwide. Evidence to date suggests that younger-onset type 2 diabetes may be more aggressive than later-onset disease with faster deterioration in β-cell function— the cells in the pancreas that produce and release insulin— and a greater excess risk of complications such as cardiovascular disease and kidney disease.
There are also concerns that earlier — and longer — lifetime exposure to hyperglycaemia (high blood sugar) in people with younger-onset type 2 diabetes increases the risk of complications and reduces life expectancy; however, research needs to define these relationships and speculate on causes, especially for adults diagnosed with the disease when aged 25-39 years, but also for people diagnosed even younger.
According to the paper, the study followed a group of 4,550 participants with newly diagnosed type 2 diabetes, aged 25–65 years with either younger-onset or later-onset diabetes over 30 years, looking at rates of diabetic complications. The investigators identified that a lower age at diagnosis was associated with a higher risk of incident diabetes-related complications, a higher relative risk of death, and persistently poorer blood sugar control.
The authors say their data support the need to develop strategies to provide high-quality care for young adults with type 2 diabetes. They also call for clinical trials dedicated to developing tailored treatments and approaches to help prevent or delay complications including death.
For India, these findings are even more concerning as India, owing to its huge population, is called the diabetes capital of the world. According to endocrinologists practising in India, the age of diabetes onset is reducing largely due to the kind of unhealthy lifestyle that Indians are leading. While better care of diabetics is important, what is more important for a country like India is to put in place measures that will help prevent early onset. Prevention is better than cure, they say.
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