Middleton T L, Constantino M I, Molyneaux L, D'Souza M, Twigg S M, Wu T, Yue D K, Zoungas S, Wong J
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Diabet Med. 2020 Jun;37(6):991-999. doi: 10.1111/dme.14238. Epub 2020 Feb 5.
Type 2 diabetes diagnosed during youth and early adulthood is aggressive and associated with a high burden of vascular complications. The increase in complications is often attributed to long disease duration and poor metabolic control. Whether people with young-onset type 2 diabetes are inherently more susceptible to long-term complications than those diagnosed in later adulthood is unclear.
Prospective data from 3322 individuals, diagnosed between the age of 15 and 70 years and collected 10-25 years after diabetes diagnosis, were analysed. The cross-sectional associations between age at diagnosis and microvascular and macrovascular complications were analysed using logistic regression models, adjusted for duration of diabetes exposure and metabolic risk factors including blood pressure, cholesterol and updated mean HbA .
The prevalence of retinopathy was highest in those with young-onset type 2 diabetes (diagnosed at age 15 to <40 years). After 10-15 years' diabetes duration, the adjusted odds ratio for retinopathy in this population was 2.8 (95% CI 1.9-4.1; reference group those diagnosed at 60 to <70 years of age). The odds of retinopathy remained higher in people with young-onset type 2 diabetes after longer durations of diabetes exposure; the odds decreased with increasing age at diagnosis. This pattern was not observed in models of other complications: after 10-15 years' diabetes exposure, the adjusted odds ratios for albuminuria, peripheral neuropathy and macrovascular disease in people with young-onset type 2 diabetes were 0.5 (95% CI 0.4-0.8), 0.7 (95% CI 0.5-1.1) and 0.2 (95% CI 0.1-0.3), respectively.
After accounting for disease duration and other important confounders, people with type 2 diabetes diagnosed in youth and early adulthood (or with a younger current age) appeared to be inherently more susceptible to retinopathy. For other complications, adjusted risk appears highest in the oldest age of diagnosis group. These data have screening and treatment target implications.
青年期和成年早期诊断出的2型糖尿病病情进展迅速，且与较高的血管并发症负担相关。并发症的增加通常归因于病程长和代谢控制不佳。与成年后期诊断出2型糖尿病的患者相比，青年期发病的2型糖尿病患者是否天生更容易发生长期并发症尚不清楚。
分析了3322名个体的前瞻性数据，这些个体在15至70岁之间被诊断出患有糖尿病，数据收集于糖尿病诊断后的10至25年。使用逻辑回归模型分析诊断年龄与微血管和大血管并发症之间的横断面关联，并对糖尿病暴露时间和包括血压、胆固醇和更新后的平均糖化血红蛋白在内的代谢危险因素进行了校正。
青年期发病的2型糖尿病患者（15岁至<40岁诊断）视网膜病变患病率最高。糖尿病病程10至15年后，该人群视网膜病变的校正比值比为2.8（95%可信区间1.9 - 4.1；参照组为60岁至<70岁诊断的患者）。糖尿病暴露时间更长后，青年期发病的2型糖尿病患者视网膜病变的几率仍然更高；随着诊断年龄的增加，几率降低。在其他并发症模型中未观察到这种模式：糖尿病暴露10至15年后，青年期发病的2型糖尿病患者蛋白尿、周围神经病变和大血管疾病的校正比值比分别为0.5（95%可信区间0.4 - 0.8）、0.7（95%可信区间0.5 - 1.1）和0.2（95%可信区间0.1 - 0.3）。
在考虑病程和其他重要混杂因素后，青年期和成年早期诊断出的2型糖尿病患者（或当前年龄较小的患者）似乎天生更容易患视网膜病变。对于其他并发症，校正后的风险在诊断年龄最大的组中似乎最高。这些数据对筛查和治疗目标具有启示意义。
