“I think this is an important paper,” says Tom Donner, MD, director of the John Hopkins Diabetes Center in Baltimore, who was not involved in this research. “It really helps solidify beliefs we’ve had for some time, which is that the complication rates for people with diabetes are linked to how long they’ve had the disease and how high their blood sugar levels are.” Not only are more people in the United States being diagnosed with type 2 diabetes, it’s happening at a younger age. “It’s been relatively recently — in the last 10 or 20 years — that we’ve started to see people who develop type 2 diabetes before age 30,” says Dr. Donner. “We’re seeing children now who develop type 2 diabetes. This is worrisome because we really think that the clock for complications starts ticking when the diabetes is diagnosed,” says Donner. RELATED: What Are the Possible Complications of Type 2 Diabetes, and How Can You Avoid Them?
Calculating the Risk for Complications According to Age at Diabetes Diagnosis
Using data from the Swedish National Diabetes Registry, researchers looked at 318,083 people with type 2 diabetes and 1,575,108 people without the condition. To compare similar people from each group, they matched participants by age, sex, and county. Researchers followed both groups from 1998 to 2013 to track their rates for heart disease, heart attack, stroke, and hospitalization from heart failure and atrial fibrillation. They tracked deaths resulting from heart disease or any other cause from 1998 to 2014. This study is the first to compare the excess risks of dying from or developing cardiovascular disease in people diagnosed with type 2 diabetes and to adjust the risk for these outcomes according to how long a person has had diabetes — an independent risk factor associated with cardiovascular disease risk, researchers said. During a median follow-up of nearly two and a half years, researchers compared results with those of control participants of similar age without type 2 diabetes and found:
Participants diagnosed before age 40 with type 2 diabetes had the greatest excess risk for death, stroke, heart attack, heart failure, or atrial fibrillation — at least 3 times greater than for the group without type 2 diabetes.Women generally carried higher excess cardiovascular disease and mortality risks than men in most categories.Excess risks for cardiovascular disease and life years lost declined steadily with the age of diagnosis.
The risk factors are so much higher in the under-40 population because it appears that weight and other risk factor levels have to be much higher to develop diabetes at a much younger age, says Naveed Sattar, MD, PhD, lead study author and professor of metabolic medicine at the University of Glasgow in the United Kingdom. “We also know that [blood] sugar levels worsen more quickly in people who develop diabetes when young, whereas those levels are much more stable when one develops diabetes above age 75 to 80, for example,” he says. RELATED: How to Help Stabilize Your Blood Sugar Researchers also used to the data to estimate median loss of life in relation to age of diagnosis. “People developing [type 2] diabetes under around age 20 lose well over a decade of life, which is on par with what is seen in people with type 1 diabetes,” says Dr. Sattar. When diagnosed with type 2 diabetes at age 45, the median loss of life was about 6 years, and 2 years when diagnosed at 65. There was no difference in life expectancy for people after age 80. The risk for cardiovascular events weren’t any greater for people age 80 or older who were diagnosed with type 2 diabetes. This doesn’t undercut the risks of type 2 diabetes; it actually supports the findings, says Donner. “It goes along with the complications being tied to how long the disease has been present. If you’re 80 at the time of diagnosis, you just don’t have 30 or 40 years to see those develop,” he says. RELATED: Younger Diabetes Diagnosis Tied to Greater Risk of Death From Heart Disease That finding also fits with the American Diabetes Association’s recommendation, published in January 2018 in the journal Diabetes Care, that as people with type 2 diabetes get older, their healthcare providers should reduce the intensity of their diabetes control to minimize the side effects of the medication, says Donner. “We know patients over age 80, even in their seventies, are unlikely to develop severe diabetes-related complications. The older population is more at risk from side effects of their medication,” says Donner. Further research is needed to fully understand why the risk for women was generally higher than for men in these findings, says Donner. “That’s something that hasn’t been well understood. Overall, women tend have less heart disease than men do, but for women who develop diabetes that benefit is essentially eliminated. That’s something that’s been seen in other studies but we’re not sure why.” This excess risk for women with type 2 diabetes is discussed in an article published in April 2015 in the journal Current Hypertension Reports. RELATED: How Type 2 Diabetes and Heart Disease Are Connected
Increased Risks for Cardiovascular Events Likely Go Beyond Blood Sugar
Anytime you look at big population studies, it’s hard to control for things that might be associated with early onset of diabetes, says Donner. “A person’s weight, physical activity, eating habits, lifestyle — these are all associated with the propensity to develop type 2 diabetes,” he adds. “It’s hard to factor out those other risk factors for heart disease. My suspicion is that in a population of patients that develops diabetes there are other things that would be expected to be more prominent, including higher blood pressure, higher weight, higher cholesterol levels, and lesser physical activity, all of which also increase their risk for heart disease,” he says. “You cannot say that it’s blood sugar control alone in this study that’s leading to higher rates of heart disease,” says Donner. RELATED: The Ways Your Genes May Affect Your Risk for Diabetes
It’s Never Too Early or Too Late to Adopt a Healthy Lifestyle
Even if you’ve already been diagnosed with diabetes, you can still reduce your risk of cardiovascular events and early death, says Donner. “The medications we use for diabetes are quite effective in lowering average blood sugar level, and we know that the lowering of blood sugar helps prevent long-term complications,” he adds. “Noncompliance for physicians is worrisome because that would tend to put patients at risk for having uncontrolled diabetes,” he says. “At any stage of the disease, regardless of the number of complications that have already developed, people can still lessen the likelihood that the disease will progress with better blood sugar control, cholesterol control, blood pressure control — all the risk factors for heart disease,” says Donner. RELATED: 8 Steps to Manage Both Diabetes and Heart Health If you’re under age 70 with type 2 diabetes risk factors, like a family history or being overweight, you should try to reduce your risk of developing diabetes, says Sattar. “Change your diet to slow weight gain or lose weight,” says Sattar. “Small, sustainable lifestyle changes can make big differences in reducing the risks of diabetes,” he says. “We are we eat, we are how active we are, and our health is reflected by our weight,” says Donner. “It’s challenging in the world we live in. Portion sizes are larger, and a lot of foods have sugars and fats added to them. People aren’t as active as they once were. We should be teaching healthy habits beginning with kids in grade school. It’s a good life lesson to know: Living healthy has long-term benefits,” says Donner.
