DIABETES diagnosis at a younger age increases morbidity and mortality in older adults, according to novel data for a population-based longitudinal health interview study, which saw people diagnosed in their 50s have worse outcomes than those who were diagnosed in their 60s and 70s.
Judy Zhong, New York University (NYU) Grossman School of Medicine, New York City, USA, and colleagues looked at the result of the Health and Retirement Study survey of 7,739 adults aged 50 and older. They discovered that being diagnosed with diabetes between 50–59 years-old was associated with significant mortality compared with matched controls without a diabetes diagnosis (hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.29–1.71). Individuals aged 50–59 also had significant associated risk for several other comorbidities compared with the controls, such as incident heart disease (HR: 1.66; 95% CI: 1.40–1.96), stroke (HR: 1.64; 95% CI: 1.30–2.07), disability (HR: 2.08; 95% CI: 1.59–2.72), and cognitive impairment (HR: 1.30; 95% CI: 10.5–1.61).
However, Zhong and colleagues found that these associated risks were not as high in individuals diagnosed with diabetes when aged 60–69. Although the risks were still significant, with a higher risks of death (10%), incident heart disease (25%), disability (44%), and stroke (41%) than matched controls, there was no higher risk for cognitive impairment.
Adults diagnosed with diabetes when aged 70 or older had even fewer risks, seeing only an 8% higher risk for mortality and 15% higher risk of heart disease compared with matched controls. Furthermore, the other associations were insignificant compared with the control patients.
The researchers suggested that these findings could be as a result of younger adults being diagnosed with more aggressive forms of diabetes, with worse glycaemic control, insulin resistance and insufficiency, and β-cells dysfunction. However, the researchers noted that the link between “earlier diabetes diagnosis to worse outcomes are not completely understood.” They stated: “The longer duration of diabetes in individuals with earlier diagnosis has been reported in several previous studies. In contrast, in our study, the age-at-diagnosis association persisted when diabetes duration was fully adjusted by comparing incident outcomes starting from the age at diabetes diagnosis.”