Young-Onset Type 2 Diabetes Linked With Higher Risk of Retinopathy in Men

Risk of retinopathy may increase with diabetes duration, particularly in male patients with young-onset type 2 diabetes (T2D), according to abstract findings presented recently at the virtual Annual Meeting of the European Association for the Study of Diabetes (EASD) and to be published in Diabetologia.

Amid an increasing incidence of type 1 diabetes and T2D in younger generations, researchers noted that patients with young-onset T2D incur a high lifetime risk of complications and reduced life expectancy.

Notably, incidence of retinopathy, one of the leading causes of blindness among working-age adults worldwide, has been indicated to affect up to 80% of patients within 15 years after diabetes diagnosis, which may pose a substantial financial burden for these populations if left untreated.

Seeking to further investigate the prevalence of retinopathy and coronary heart disease (CHD), another common complication, in patients with young-onset T2D, the investigators conducted a cross-sectional study of data collected from Norwegian general practice electronic medical records (EMRs).

In the study, EMRs of 10,242 adults with T2D from 2014 were collected. Additionally, to explore relationships between age at diagnosis and complications, they compared patients with young-onset T2D (diagnosis by age 40 years) and those diagnosed at 50 years or older (n = 6627) on clinical outcomes, retinopathy, and CHD via multivariate logistic regression, with multilevel multiple imputation performed to reduce potential bias due to missing data, noted researchers.

Within the cohort, prevalence of young-onset T2D was 10.2% (n = 980; 55.6% were male), in which mean age was 33.3 years at diagnosis and 44.7 years in 2014. Comparably, the mean age for the cohort aged 50 and older was 62.7 years at diagnosis and 70.4 years in 2014.

Compared with the 50 and older cohort, mean glycated hemoglobin (A1C) levels were indicated to be higher in patients with young-onset T2D (60 mmol/mol vs 52 mmol/mol), with incidence of high A1C levels found more frequently at diagnosis in these populations as well (7.6% vs 6.9%). Higher A1C levels were observed in men with young-onset T2D, but levels were similar in women of both age groups.

“In those with young-onset T2D, A1C levels were higher already from the point of diabetes diagnosis but also increased more rapidly with time,” noted the accompanying press release. “In other words, if 2 people had T2D for the same length of time, A1C levels would likely be higher in the one diagnosed at a younger age.”

In assessing disease-related complications, retinopathy was shown to develop at an earlier age, with prevalence found to be nearly 3 times higher in patients with young-onset diabetes compared with those who received a diagnosis at 50 years or older (15.5 vs 5.9%).

After accounting for potential confounders, risk of retinopathy was significantly higher in both male and female patients with young-onset T2D. However, after further adjusting for potential mediators (diabetes duration, A1C, and systolic blood pressure), risk was reported to remain significantly high in men with young-onset T2D compared with those diagnosed at 50 or older (odds ratio, 1.72; 95% CI, 1.29-2.29), but not in women (odds ratio, 1.34; 95% CI, 0.95-1.89).

Risk of CHD was shown to be more related to current age than to diabetes duration. Of note, study authors said that diagnosis of T2D may be more likely to be delayed in men, who tend to visit their general practitioner less often than women.

“It is important that young-onset T2D is detected early enough and treated adequately to reduce the likelihood of retinopathy and other complications,” said study author Katrina Tibballs, PhD student at the University of Oslo, Norway, in a statement. “The current guidelines on diabetes prevention and treatment should be updated to reflect the higher risk of complications in those with young-onset diabetes, particularly the elevated risk of retinopathy in men.”

Reference

Tibballs KL, Jenum AK, Sandberg S, et al. Young-onset type 2 diabetes: clinical outcomes in Norwegian general practice. Presented at: EASD Annual Meeting 2021; September 27-October 1, 2021; Stockholm, Sweden. Abstract 139.