Age at T2D diagnosis is highly prognostic of survival and CV risk

  • Sattar N & al.
  • Circulation
  • 8 Apr 2019

  • International Clinical Digest
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Takeaway

  • Age at diagnosis of type 2 diabetes (T2D) affects survival and cardiovascular (CV) risks.
  • Findings suggest appropriate intensity of T2D management may differ by onset age.

Why this matters

  • T2D is increasingly diagnosed in adolescents and young adults.
  • Overtreatment is common in older adults.

Study design

  • Swedish National Diabetes Registry data for 318,083 with T2D without baseline CV disease matched with 5 controls each for age, sex, residence county.
  • Funding: Swedish Association of Local Authorities Regions; others.

Key results

  • In median 5.63-year follow-up, those with T2D diagnosed at age ≤40 years had highest excess relative risk for most outcomes, including (95% CIs):
    • Total mortality: 2.05 (1.81-2.33); 
    • CV-related mortality: 2.72 (2.13-3.48);
    • Non-CV mortality: 1.95 (1.68-2.25); 
    • Coronary heart disease: 4.33 (3.82-4.91);
    • Acute myocardial infarction: 3.41 (2.88-4.04); and
    • Heart failure: 4.77 (3.86-5.89).
  • For T2D diagnosed at age >80 years, adjusted relative risks were
  • Total mortality: 0.83 (0.80-0.86); 
  • CV mortality: 0.75 (0.71-0.79); and
  • Non-CV mortality: 0.87 (0.83-0.91).
  • Risk was higher in women for coronary heart disease, stroke, and heart failure (P<.0001 for sex-by-age but excess risk diminished at age>70 years.
  • Limitations

    • Risk factor capture in controls not systematic.
    • All-Swedish, mostly white population.

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