NEWS & PERSPECTIVE

Young people with diabetes are at a higher risk of complications and death

The prevalence of diabetes has been rising both locally and globally, with 400 million people affected worldwide and over half being Asians.1 For type 2 diabetes mellitus (T2DM), industrialization and urbanization are known to be the risk factors associated with obesity and overweight in all age groups which can lead to the development of T2DM.2 In a recent study from The Chinese University of Hong Kong, young people with diabetes were found to be more likely to develop complications and deaths as compared to the older diabetic patients.1

In a study examining the secular trend of diabetes in Hong Kong between 2002 and 2015 (n=562,022), the incidence of type 1 diabetes mellitus (T1DM) increased among people aged under 20 years, but remained stable in other age groups.1 The incidence of T2DM also increased among those aged under 40 years and accounted for over half of the new diabetes cases among people aged under 20 years.1 In people aged ≥40 years, the incidence of T2DM remained constant.1 This observation is alarming as it may indicate a higher mortality rate related to diabetes in the younger population. Compared to those without diabetes, people with diabetes are at a higher risk of death from all causes and from a wide range of diabetes-related complications including cardiovascular disease (CVD), cancer and renal disease.3 In order to describe the trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, researchers from the Faculty of Medicine at The Chinese University of Hong Kong has conducted an analysis on the data of 770,000 people with diabetes in Hong Kong from 2001 to 2016.4

This 16-year study revealed major declines in mortality rates from all causes, CVD, and cancer, as well as decline in all-cause mortality relative to the non-diabetic population, in the local diabetic population over the study period.4 The mortality rates for all-cause, CVD, and cancer among people with diabetes declined by 52.3%, 72.2%, and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively.4 Besides, the standardized mortality ratios (SMRs) in all age groups, comparing all-cause mortality rates in people with and without diabetes, declined from 2.82 (95% CI: 2.72-2.94) to 1.50 (95% CI: 1.46-1.54) in men, and for women declined from 3.28 (95% CI: 3.15-3.41) to 1.67 (95% CI: 1.62-1.72).4

However, the declines were more obvious in the older than the younger age groups.4 In the older age group, the decrease in all-cause mortality rates in people with diabetes was mainly due to the significant improvement in mortality rates from CVD and cancer.4 Better diabetes management and patient education were the key to lower deaths and complications in older patients with diabetes.4 Opposite to this observation, the declines in all-cause mortality rates over the study period among people aged 20-44 years were not statistically significant for both men (average annual percent change [AAPC]=-3.2%; 95% CI: -7.3%-1.0%) and women (AAPC=-1.2%; 95% CI: -6.5%-4.4%).4 That said, the SMRs for this group of people fluctuated over time between 7.86 (95% CI: 5.74-10.5) in men and 6.10 (95% CI: 3.68-9.45) in women in 2001, and 4.95 (95% CI: 3.72-6.45) in men and 4.92 (95% CI 3.25-7.12) in women in 2016.4

Another 7-year study further demonstrated that people under the age of 40 were likely to have a poorer control of glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL)-cholesterol than other age groups, suggesting that younger people with diabetes have poor adherence to treatment and medical follow-up.2

In short, young people are more likely to develop complications and deaths from diabetes. Among the high-risk young diabetes population, it is crucial to manage diabetes as early as possible, to improve outcome or even alter prognosis.4 T2DM can be prevented or delayed through lifestyle modification, and the involvement of a more healthy diet and physical activity can significantly lower the risk of diabetes-related complications and deaths.2

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