High risk of conversion to diabetes in first-degree relatives of individuals with young-onset type 2 diabetes: a 12-year follow-up analysis

Objectives: 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 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. Results: 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). Conclusions: Unlike usual-onset, 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.

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Temporal Trend in Young-Onset Type 2 Diabetes - the Macrovascular and Mortality Risk: Study of UK Primary Care Electronic Medical Records

10.2337/figshare.12357320.v1 ◽

2020 ◽

Author(s):

Digsu N. Koye ◽

Joanna Ling ◽

John Dibato ◽

Kamlesh Khunti ◽

Olga Montvida ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Risk Factor ◽

High Risk ◽

Mortality Risk ◽

Cardiometabolic Risk ◽

Low Risk ◽

Young Onset ◽

Onset Type

Objectives: 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 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. Results: 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). Conclusions: Unlike usual-onset, 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.

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522-P: Long-Term Renal Outcomes in Young Onset Type 2 Diabetes

Diabetes ◽

10.2337/db19-522-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 522-P

Author(s):

TIMOTHY MIDDLETON ◽

STEVE CHADBAN ◽

LYNDA M. MOLYNEAUX ◽

MARIO I. D'SOUZA ◽

MARIA I. CONSTANTINO ◽

...

Keyword(s):

Type 2 Diabetes ◽

Young Onset ◽

Onset Type ◽

Renal Outcomes

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Kidney Disease and Youth Onset Type 2 Diabetes: Considerations for the General Practitioner

International Journal of Pediatrics ◽

10.1155/2012/237360 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Allison B. Dart ◽

Elizabeth A. Sellers ◽

Heather J. Dean

Keyword(s):

Type 2 Diabetes ◽

High Risk ◽

Kidney Disease ◽

Complex Disease ◽

Early Adulthood ◽

Primary Care Providers ◽

High Risk Group ◽

Care Providers ◽

Onset Type

Youth onset type 2 diabetes (T2DM) continues to increase worldwide, concomitant with the rising obesity epidemic. There is evidence to suggest that youth with T2DM are affected by the same comorbidities and complications as adults diagnosed with T2DM. This review highlights specifically the kidney disease associated with youth onset T2DM, which is highly prevalent and associated with a high risk of end-stage kidney disease in early adulthood. A general understanding of this complex disease by primary care providers is critical, so that at-risk individuals are identified and managed early in the course of their disease, such that progression can be modified in this high-risk group of children and adolescents. A review of the pediatric literature will include a focus on the epidemiology, risk factors, pathology, screening, and treatment of kidney disease in youth onset T2DM.

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Predicting young-onset type 2 diabetes mellitus with metabolic syndrome components in healthy young adults

International Journal of Clinical Practice ◽

10.1111/ijcp.13238 ◽

2018 ◽

Vol 72 (9) ◽

pp. e13238

Author(s):

Chung-Ze Wu ◽

Jin-Sheun Chen ◽

Yuh-Feng Lin ◽

Chang-Hsun Hsieh ◽

Jiunn-Diann Lin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Type 2 Diabetes Mellitus ◽

Young Adults ◽

Young Onset ◽

Onset Type ◽

Metabolic Syndrome Components

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Reduced beta cell function in offspring of mothers with young-onset type 2 diabetes

Diabetologia ◽

10.1007/s00125-006-0285-5 ◽

2006 ◽

Vol 49 (8) ◽

pp. 1876-1880 ◽

Cited By ~ 19

Author(s):

R. Singh ◽

E. Pearson ◽

P. J. Avery ◽

M. I. McCarthy ◽

J. C. Levy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Young Onset ◽

Onset Type

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Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01168-4 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Rosalia Dettori ◽

Andrea Milzi ◽

Kathrin Burgmaier ◽

Mohammad Almalla ◽

Martin Hellmich ◽

...

Keyword(s):

Type 2 Diabetes ◽

Optical Coherence Tomography ◽

High Risk ◽

Clinical Parameters ◽

Optical Coherence ◽

Plaque Vulnerability ◽

High Risk Patients ◽

Risk Patients

Abstract Background Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM. Methods 81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed. Results During follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07–1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44–8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21–8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000°*mm, 95% CI 1.21–2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02–3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns). Conclusion Clinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.

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