<b>Objectives: </b>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.
<p><b>Research Design
and Methods: </b>From the UK primary care database, 370,854 people with
new diagnosis of type 2 diabetes from 2000 to 2017 were identified. Analyses
were conducted by age groups (18-39, 40-49, 50-59, 60-69, 70-79 years) and high/low
risk status without history of ASCVD at diagnosis - ≥ two of current smoking,
high SBP, high LDL-C or chronic kidney disease were classified as high-risk. </p>
<p><b>Results:</b> Proportion
of people aged <50 years at diagnosis increased during 2000-2010 and then stabilised.
The incidence rates of ASCVD and ACM declined in people aged ≥50 years, but did
not decrease in people <50 years. Compared to people aged ≥50 years, those
aged 18-39 years at diagnosis had higher obesity (71% obese), higher HbA1c
(8.6%), 71% had high LDL-C, while only 18% were on cardio-protective therapy.
Although 2% in this age group had ASCVD at diagnosis, 23% were identified as
high-risk. In the 18-39 years group, the adjusted average years to ASCVD /ACM
in high-risk individuals (years (95% CI): 9.1 (8.2–10.0) /9.3 (8.1–10.4)) were
similar to those with low-risk (years (95% CI): 10.0 (9.5 – 10.5) /10.5 (9.7–11.2)).
However, individuals ≥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 to
low-risk groups (p<0.01). </p>
<p><b>Conclusions: </b>Unlike usual-onset,<b>
</b>young-onset
type 2 diabetes have similar cardiovascular and mortality risk irrespective of
their 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 re-evaluated through prospective
studies.<b> </b></p>
Multiple risk factor intervention reduces carotid atherosclerosis in patients with type 2 diabetes