1336-P: High Prevalence of Complications in Young-Onset Type 2 Diabetes

Introduction & Objective: The prevalence of type 2 diabetes (T2D) in young adults (age <45 years) is increasing. There is limited data on the burden of diabetes-related complications in young-onset type 2 diabetes (YOT2D).

Methods: Adults with the diagnosis of T2D (ICD codes 250.xx and E11.xx; n=352 826) were identified from the Utah Diabetes Database, a subset of the Utah Population Database. The cohort was divided based on age at first diagnosis of T2D: YOT2D were first diagnosed between 18-44 years old and later-onset type 2 diabetes (LOT2D) were first diagnosed at ≥45 years old. Those with missing data (n=296 295) or laboratory data consistent with type 1 diabetes (n=204) were excluded.

Results: Of the 56 327 people with T2D included, 33% (n=13 087) had YOT2D and 77% (n=43 240) had LOT2D. The mean age at first diagnosis was 35±7 years in YOT2D vs 62±10 years in LOT2D. Female sex, ethnic minorities (Hispanics, non-Hispanic Black, Asian, Pacific Islanders, American Indians), and a positive family history of T2D were associated with YOT2D (p<0.001). YOT2D had a higher prevalence of obesity (68% vs 62%, p<0.001) and were more likely to have DKA and hypoglycemia despite similar C-peptide concentrations and insulin use compared to LOT2D. Glycemic control was worse in YOT2D, both at diagnosis (HbA1c 7.8±2.5 vs 7.2±2.0%, p<0.001) and at 5 years follow up (HbA1c 7.6±3.0 vs 7.1 ±4.8%, p<0.001). Risk for advanced hepatic fibrosis, as determined by the APRI score >0.7, were equally high in both groups (6.9% vs 6.6, p=0.36). Similarly, frequencies of retinopathy (10%) and foot ulceration (3%) were no different. Overall, significant proportions of each group had moderately increased albuminuria (urine albumin ≥ 30 mg/g: 36% vs 34%, p<0.003), diabetic nephropathy (13% vs 18%, p<0.001), and diabetic neuropathy (17% vs 24%, p<0.001).

Conclusion: YOT2D is associated with high prevalence of diabetes-related complications. Precision-focused mitigation strategies are needed to decrease excess adverse outcomes in YOT2D.