A large new study shows that the age at which a person is diagnosed with type 2 diabetes can make a big difference to their risk of heart disease, as well as how long they can expect to live. The Research published earlier this week in the journal Rotationthat people under the age of 40 who were diagnosed with type 2 diabetes were two to three times more likely to have heart-related death compared to people in the same age group without type 2 diabetes. The heart rate is 4 to 5 times higher for people under the age of 40 who have type 2 diabetes than for people without the condition.
“I think this is an important paper,” she says. Tom Donner, MD, director of the Johns Hopkins Diabetes Center in Baltimore, who was not involved in this research. “It really helps cement beliefs that we’ve had for some time, which is that complication rates for people with diabetes are related to how long they have the disease and how high their blood sugar levels are.”
More people in the United States are not only being diagnosed with type 2 diabetes, but it is occurring at a younger age. “It’s been relatively recently – in the last 10 or 20 years – that we start seeing people develop type 2 diabetes before the age of 30,” says Dr. Donner. “We are now seeing children who develop type 2 diabetes. This is concerning because we really believe that the time for complications begins when diabetes is diagnosed,” Donner says.
Related: What are the possible complications of type 2 diabetes and how can you avoid them?
Calculating the risk of complications by age when diagnosed with diabetes
Using data from the Swedish National Diabetes Registry, researchers studied 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, gender, and province. Researchers followed both groups from 1998 to 2013 to track rates of heart disease, heart attack, stroke, hospitalization for heart failure, and atrial fibrillation. They tracked deaths from heart disease or any other cause from 1998 to 2014.
This study is the first to compare the increased risk of death or cardiovascular disease in people diagnosed with type 2 diabetes and adjust the risk of these outcomes according to the person’s duration of diabetes — an independent risk factor associated with cardiovascular disease, the researchers said.
During an average follow-up of about two and a half years, the researchers compared the results with those of participants in a control group of the same age without type 2 diabetes and found:
- Participants diagnosed before the age of 40 with type 2 diabetes had the highest risk of death, stroke, heart attack, heart failure, or atrial fibrillation — at least 3 times greater than the group without type 2 diabetes.
- Women generally carry excess cardiovascular disease and a higher risk of death than men in most groups.
- The increased risk of cardiovascular disease and years of life lost steadily declined with the advancing age of diagnosis.
The risk factors are much higher in people younger than 40 because it appears that weight and levels of other risk factors must be much higher for developing diabetes at a much younger age, he says. Naveed Star, MD, PhD, lead study author and professor of metabolic medicine at the University of Glasgow in the UK. “We know that too [blood] Sugar levels worsen more quickly in people who develop diabetes when they are young, while those levels are more stable when one develops diabetes over the age of 75 to 80, for example,” he says.
Related: How does it help stabilize blood sugar?
The researchers also used the data to estimate the average loss of life in relation to the age of diagnosis. “People are evolving [type 2] Dr. Abdul Sattar says that diabetes under the age of 20 loses more than a decade of life, which is on par with what we see in people with type 1 diabetes.” When diagnosed with type 2 diabetes at age 45, the average losses were In life about 6 years, and 2 years at diagnosis at age 65. There was no difference in life expectancy for people after age 80.
The risk of cardiovascular events was not greater for people 80 years of age or older who were diagnosed with type 2 diabetes. This does not reduce the risk of type 2 diabetes; Donner says he already supports the results. It is in line with complications that are related to the duration of the disease. If you were 80 years old at the time of diagnosis, you would not have 30 or 40 years to develop.
Related: A smaller diagnosis of diabetes is associated with an increased risk of death from heart disease
This result is also consistent with the findings of the American Diabetes Association Recommendation, published in January 2018 in the magazine Diabetes careAs people with type 2 diabetes get older, Donner says, health care providers should reduce the severity of their diabetes control to reduce medication side effects. We know that patients over 80 years of age, even in their 70s, are less likely to develop serious complications associated with diabetes. “Older adults are at greater risk of side effects from their medication,” Donner says.
Donner says more research is needed to understand why women in general are at higher risk compared to men with these findings. “This is something that is not well understood. In general, women tend to have less heart disease than men, but for women with diabetes, this benefit is essentially eliminated. This is something that has been seen in other studies but we are not sure why.” This increased risk for women with type 2 diabetes is discussed in Article published in April 2015 in the magazine Current high blood pressure reports.
Related: How is type 2 diabetes and heart disease linked?
The increased risk of cardiovascular events likely exceeds blood sugar
Anytime you look at large population studies, it’s hard to control for things that might be associated with early onset of diabetes, Donner says. “A person’s weight, physical activity, eating habits, and lifestyle – all are associated with a tendency to develop type 2 diabetes,” he adds.
“It is difficult to identify other risk factors for heart disease. I suspect that in the group of patients who develop diabetes there are other things that would be expected to be more prominent, including high blood pressure, being overweight, high cholesterol levels, and low physical activity , all of which also increase their risk of developing heart disease,” he says. “You can’t say that glycemic control alone in this study leads to higher rates of heart disease,” Donner says.
Related: The ways your genes may influence your diabetes risk
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 lower your risk of cardiovascular disease and early death, Donner says. “The medications we use for diabetes are very effective in lowering the average blood sugar level, and we know lowering blood sugar helps prevent long-term complications,” he adds. “The doctors’ non-compliance is concerning because it would put patients at risk of developing uncontrolled diabetes,” he says.
“At any stage of the disease, and no matter how many complications have already developed, people can still reduce the likelihood of disease progression with better blood sugar control, cholesterol control, and blood pressure control — all risk factors for heart disease,” Donner says.
Related: 8 steps to managing both diabetes and heart health
If you’re under 70 with risk factors for type 2 diabetes, such as a family history or being overweight, you should try to lower your diabetes risk, Starr says. “Change your diet to slow weight gain or loss,” says Abdul Sattar. “Small, sustainable lifestyle changes can make big differences in reducing diabetes risk,” he says.
“We eat, how active we are, and our health is reflected in our weight,” Donner says. “It’s a challenge in the world we live in. Portion sizes are bigger, and a lot of foods have sugars and fats added to them. People are not as active as they used to be. We should teach healthy habits starting with children in elementary school. It’s a good life lesson to be Know it: Living healthy has long-term benefits, Donner says.