ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This population-based cohort study estimated all-cause and cause-specific mortality in 108,061 individuals with newly diagnosed T2D, (16–50 years of age) compared to 829,946 individuals without T2D. Higher relative risks of mortality in younger individuals with vs. without T2D ranged from 4 to 11, depending on the cause of death.

Comment: A decade ago, a Markov-like computer model simulated the life course of a hypothetical cohort of U.S. adolescents and young adults aged 15–24 years newly diagnosed with T2D. The model predicted that while a 20-year-old without diabetes has an average remaining life expectancy of 58 years, those with T2D can expect only 43 years - a loss of ~15 years. The model also suggested that these individuals might face severe, chronic complications emerging by their 40s.

Now, this large, multiethnic, nationally representative cohort study confirms those grim predictions. Across all causes of death, mortality risk was consistently higher in individuals with T2D. The relative risk of all-cause mortality was particularly alarming in those aged 16 to 27, where it was more than 4-times higher, and gradually declined to 1.5 in the 48- to 50-year age group. Cardiorenal mortality, risk was even more severe, soaring over 10-fold in the youngest group and tapering to 2-fold in those nearing 50. Cancer-specific mortality also peaked among the youngest individuals, with the relative risk reaching 3.7 in those aged 16 to 27. Individuals with T2D had higher BMI, systolic blood pressure, and LDL level, reported more active smoking and were more likely to be in the most deprived socioeconomic quintile.

Although the absolute risk of events in individuals diagnosed with T2D at a young age was low, these findings underscore the need for strategies focused on screening for T2D at younger ages and tailoring therapeutic approaches to prevent diabetes-related complications and mortality in this population.

Reference: 1. Rhodes ET, Prosser LA, Hoerger TJ, Lieu T, Ludwig DS, Laffel LM. Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus. Diabet Med. 2012 Apr;29(4):453-63. doi:10.1111/j.1464-5491.2011.03542.x. PMID: 22150528.