Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation
Combined analysis of individual-participant data from 19 high-income countries found that every decade of earlier diagnosis of diabetes linked to ~3–4 years of lower life expectancy, highlighting need to develop & implement interventions that prevent or delay onset of diabetes.
Source:
The Lancet Diabetes & Endocrinology
SPS commentary:
The hazard ratios for risk of all-cause mortality compared with participants without diabetes were 2.69 (95% CI 2.43–2.97) when diagnosed at 30–39 years, 2.26 (2.08–2.45) at 40–49 years, 1.84 (1.72–1.97) at 50–59 years, 1.57 (1.47–1.67) at 60–69 years, and 1.39 (1.29–1.51) at 70 years and older.
According to a commentary, people with young-onset type 2 diabetes are more insulin-resistant, have less pancreatic reserve, have greater difficulty achieving glycaemic control, and have a greater risk of complications than those diagnosed at an older age, and surprisingly, the most prominent causes of the mortality differential identified in this group were neither cardiovascular nor neoplastic. Instead, the reduction in life expectancy was predominantly due to deaths from other causes, including disorders of the respiratory, digestive, and nervous systems; external causes; mental health disorders; and infectious and renal diseases. It calls for better characterisation of the epidemiology of young-onset type 2 diabetes to advance its control. It discusses a new set of risk factors acting more in younger than in older people, such as decreased β-cell mass, an intergenerational effect of maternal gestational diabetes, but less frequently mentioned is the added risk accruing from the ongoing nutritional transition, including the shift to a greater intake of ultraprocessed food, which is widespread in childhood and, among adults. It questions to what degree these findings are reflective of most of the world's population—those who live in low-income and middle-income countries- with the 2021 Diabetes Atlas estimating that these countries will be responsible for 94% of the increase in diabetes prevalence worldwide by 2045.