Endocrinol Metab.  2022 Aug;37(4):641-651. 10.3803/EnM.2022.1501.

Characteristics of Glycemic Control and Long-Term Complications in Patients with Young-Onset Type 2 Diabetes

• Baek Hs
• Park JY
• Yu J
• Lee J
• Yang Y
• Ha J
• Lee SH
• Cho JH
• Lim DJ
• Kim HS

• KMID: 2532864
• DOI: http://doi.org/10.3803/EnM.2022.1501

Abstract

Background
The prevalence of young-onset diabetes (YOD) has been increasing worldwide. As the incidence of YOD increases, it is necessary to determine the characteristics of YOD and the factors that influence its development and associated complications.
Methods
In this retrospective study, we recruited patients who were diagnosed with type 2 diabetes mellitus between June 2001 and December 2021 at a tertiary hospital. The study population was categorized according to age: YOD (age <40 years), middle-age-onset diabetes (MOD, 40≤ age <65 years), and late-onset diabetes (LOD, age ≥65 years). We examined trends in glycemic control by analyzing fasting glucose levels during the first year in each age group. A Cox proportional-hazards model was used to determine the relative risk of developing complications according to glycemic control trends.
Results
The fasting glucose level at the time of diagnosis was highest in the YOD group (YOD 149±65 mg/dL; MOD 143±54 mg/dL; and LOD 140±55 mg/dL; p=0.009). In the YOD group, glucose levels decreased at 3 months, but increased by 12 months. YOD patients and those with poor glycemic control in the first year were at a higher risk of developing complications, whereas the risk in patients with LOD was not statistically significant.
Conclusion
YOD patients had higher glucose levels at diagnosis, and their glycemic control was poorly maintained. As poor glycemic control can influence the development of complications, especially in young patients, intensive treatment is necessary for patients with YOD.

Keyword

Diabetes mellitus; Glycemic control; Young aged

Figure

• 

  Fig. 1. Glycemic control during the first year of treatment. Each point represents mean values. (A) Glucose levels at the time of treatment initiation and 3, 6, and 12 months from treatment initiation. (B) Glycated hemoglobin (HbA1c) levels at the time of treatment initiation and 3, 6, and 12 months from treatment initiation. YOD, young-onset diabetes; MOD, middle-age-onset diabetes; LOD, late-onset diabetes. aP<0.005 (YOD), <0.001 (MOD); bP<0.005 (MOD), <0.001 (LOD); cP<0.001 (MOD), <0.005 (LOD); d,e,fP<0.001 in all age groups.

• 

  Fig. 2. The cumulative hazard curve for complications in each age group, according to glycemic control. The red line represents patients with area under the curve of the glucose level (AUCg) ≥1,433 (mg/dL)×mo and the green line represents the participants with AUCg <1,433 (mg/dL)×mo. (A) The cumulative hazard curve for overall complications in patients with young-onset diabetes (YOD). (B) The cumulative hazard curve for overall complications in patients with middle-age-onset diabetes (MOD). (C) The cumulative hazard curve for overall complications in patients with late-onset diabetes (LOD). (D) The cumulative hazard curve for microvascular complications in patients with YOD. (E) The cumulative hazard curve for microvascular complications in patients with MOD. (F) The cumulative hazard curve for microvascular complications in patients with LOD. (G) The cumulative hazard curve for macrovascular complications in patients with YOD. (H) The cumulative hazard curve for macrovascular complications in patients with MOD. (I) The cumulative hazard curve for macrovascular complications in patients with LOD.

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  Fig. 3. The hazard ratio (HR) plot of the Z-transformed area under the curve of the glucose level values for development of complications. The HRs were reported with 95% confidence intervals (CIs). (A) the HRs in patients with young-onset diabetes (YOD). (B) The HRs in patients with middle-age-onset diabetes (MOD). (C) The HRs in patients with late-onset diabetes (LOD). CI, confidence interval.

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