Life-expectancy for individuals with younger-onset disease is on average 16 years shorter compared to people without diabetes, and 10 years shorter for those diagnosed at an older age, new research has found.
Being diagnosed with Type 1 diabetes at a young age is associated with more cardiovascular complications and higher risk of premature death than being diagnosed later in life, independent of disease duration. The findings, published in The Lancet, come from a large observational study in Sweden that followed over 27,000 individuals with Type 1 diabetes and more than 135,000 matched controls for an average of 10 years.
With around half of individuals with Type 1 diabetes diagnosed before the age of 14, the authors stress the need to consider wider and earlier use of cardioprotective measures such as statins and blood pressure lowering drugs in this high-risk population.
Dr Araz Rawshani from the University of Gothenburg in Sweden who co-led the research, said: “Although the relative risk of cardiovascular disease is increased after an early diabetes diagnosis, the absolute risk is low.
“However, age at disease onset appears to be an important determinant of survival as well as cardiovascular outcomes in early adulthood, warranting consideration of earlier treatment with cardioprotective drugs.”
The new estimates suggest that individuals diagnosed before the age of 10 have a 30-times greater risk of serious cardiovascular outcomes like heart attack (0.31 cases per 100,000 person years for participants with diabetes vs 0.02 cases in every 100,000 person-years for controls) and heart disease (0.5 vs 0.03) than those in the general population, whilst risk levels are around six times higher for people diagnosed between ages 26 and 30 (0.87 vs 0.25 and 1.80 vs 0.46 respectively).
People with younger-onset Type 1 diabetes are four times as likely to die from any cause (0.61 vs 0.17), and have more than seven times the risk of dying from cardiovascular disease (0.09 vs 0.02) than their diabetes-free counterparts. In contrast, people first diagnosed between ages 26 and 30 face a lower (three-fold) risk of dying from any cause (1.9 vs 0.6) and cardiovascular disease (0.56 vs 0.15) compared to their peers without diabetes.
Co-author Professor Naveed Sattar, from the University of Glasgow, said: “While the absolute risk levels are higher in individuals who develop diabetes when older, simply due to age being a strong risk factor, the excess risk compared to healthy controls is much higher in those who developed diabetes when younger. If this higher excess risk persists over time in such individuals, they would be expected to have highest absolute risks at any given subsequent age. Indeed, those who develop Type 1 diabetes when under 10 years of age experience the greatest losses in life expectancy, compared to healthy controls. This is something we did not fully appreciate before.”