Division of Research, Kaiser Permanente Northern California, Oakland, CA
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Diabetes Care. 2020 May;43(5):975-981. doi: 10.2337/dc19-1380. Epub 2020 Mar 4.
The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes.
Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year.
Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) ( < 0.0001) and lower odds of achieving an HbA <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]).
Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.
2 型糖尿病在 45 岁以下成年人中的发病率正在上升。2 型糖尿病发病年龄越小，个体患糖尿病相关并发症的风险就越高。鉴于早期血糖控制带来的持久益处，我们比较了发病年龄较轻（21-44 岁）和中年（45-64 岁）的 2 型糖尿病患者的血糖控制和初始治疗情况。
利用来自大型综合性医疗保健系统的数据，我们确定了 32137 名（年龄 21-64 岁）患有 2 型糖尿病的成年人（HbA1c 首次升高≥6.5%[≥48mmol/mol]）。我们排除了任何有 2 型糖尿病、妊娠糖尿病或 1 型糖尿病既往史的患者。我们使用广义线性混合模型，调整人口统计学和临床变量，以检查 1 年内血糖控制和治疗的差异。
在所确定的人群中，26.4%为发病年龄较轻的患者，73.6%为发病年龄中年的患者。发病年龄较轻的成年人初始平均 HbA1c 值（8.9%[74mmol/mol]）高于中年发病的成年人（8.4%[68mmol/mol]）（<0.0001），且诊断后 1 年内 HbA1c<7%（<53mmol/mol）的可能性较低（校正比值比[aOR]0.70[95%CI0.66-0.74]），即使考虑到诊断时的 HbA1c 值也是如此。与发病年龄中年的患者相比，发病年龄较轻的成年人亲自接受初级保健的可能性较低（aOR0.82[95%CI0.76-0.89]），但通过电话接受治疗的可能性并无差异（1.05[0.99-1.10]）。发病年龄较轻的成年人开始使用二甲双胍的可能性更高（aOR1.20[95%CI1.12-1.29]），但依从性较差（0.74[0.69-0.80]）。
发病年龄较轻的 2 型糖尿病患者在诊断后 1 年内达到血糖控制的可能性较低，这表明需要采用有针对性的治疗方法来改善这一高危患者群体的预后。
