TOPLINE:

Individuals diagnosed with type 2 diabetes (T2D) between age 18-39 years had a higher risk for renal complications than individuals of the same age without T2D; however, this association decreased as the age at onset increased.

METHODOLOGY:

• With early-onset T2D on the rise and the growing burden of renal morbidities in young patients, researchers conducted a study to examine how age at onset of diabetes was associated with the subsequent risk of developing renal complications and to guide prevention and care.
• They conducted two retrospective cohort studies using electronic health records from UK and Hong Kong between 2008 and 2013.
• The analysis involved 124,610 and 183,114 patients newly diagnosed with T2D, and 4,968,819 and 3,290,862 individuals without diabetes for the UK and Hong Kong cohorts, respectively.
• Participants were stratified into six age groups based on the age of T2D onset: 18-39, 40-49, 50-59, 60-69, 70-79, and ≥ 80 years.
• Primary outcomes were chronic kidney disease (CKD), decline in renal function, and end-stage renal disease (ESRD).

TAKEAWAY:

• Over a median follow-up duration of 11.6 years in the UK cohort, the researchers found 323,597 cases of CKD, 103,441 cases of decline in renal function, and 5367 cases of ESRD; over 9.7 years in the Hong Kong cohort they found 395,025 cases of CKD, 346,508 cases of decline in renal function, and 38,029 cases of ESRD.
• In the UK cohort, individuals with T2D onset at age 18-39 had higher risks for CKD (hazard ratio [HR], 1.87; 95% CI, 1.65-2.11), decline in in renal function (HR, 4.87; 95% CI, 4.38-5.40), and ESRD (HR, 4.49; 95% CI, 3.03-6.68) than those without diabetes.
• In the UK, these risks decreased with increased age of onset; for individuals with T2D onset at age ≥ 80, risks for CKD (HR, 1.26; 95% CI, 1.21-1.32), decline in in renal function (HR, 1.66; 95% CI, 1.55-1.78), and ESRD (HR, 1.48; 95% CI, 1.12-1.96) were all reduced.
• Similar trends were observed in the Hong Kong cohort, with risks for renal complications decreasing as the age of T2D onset increased.

IN PRACTICE:

“Early T2DM [T2D] onset was identified to be associated with worse physical health outcomes, including increased renal complications for patients, which are especially important given the current rising trend of early-onset DM [diabetes] and the significant global burden of renal complications of DM in terms of quality of life,” the authors wrote.

“Such effects necessitate increased awareness and control of DM and related kidney complications in order to prevent further health deterioration. This includes preventing DM from a young age and prioritising management of early-onset T2DM,” they added.

SOURCE:

The study was led by Boyuan Wang, MPH, and Eric Yuk Fai Wan, PhD, Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong. It was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS:

The study lacked information on factors such as diet, lifestyle, socioeconomic status, diabetes treatment intensity, treatment adherence, and potential hereditary factors. Due to very low completion rates of A1c in the comparison group (< 5%), this important metric could not be included as a covariate in the primary analysis. The researchers also noted potential survivorship bias, particularly among older age groups. 

DISCLOSURES:

The study received funding from the Excellent Young Scientists Fund and National Natural Science Foundation of China. Some authors disclosed receiving research grants from various government bureaus, serving as director of a certain organization, and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.