The prevalence of newly diagnosed type 2 diabetes (T2D) among American adults under age 45 is increasing. Given the lasting benefits conferred by early glycemic control, we examined initial diabetes care and subsequent glycemic control at one year following diagnosis, comparing adults with early onset (21-<45 years old) vs. usual onset (45-<65 years old) T2D.
Using data from a large, integrated care delivery system, we identified adults who had a first diabetes-defining Hemoglobin A1c value (≥6.5% “index A1c”) between Jan. 2010 and Dec. 2016, followed by clinical diagnosis of T2D (visit with T2D ICD code or T2D on problem list) within 3 months of the index A1c. We excluded anyone with evidence of prior T2D, gestational diabetes or T1D. We compared baseline characteristics by onset age using t- or chi-2 tests. Adjusting for index A1c and other patient characteristics, we used logistic regression to examine initial management and GEE models to examine glycemic control (goal A1c <7%) at one-year following diagnosis, comparing early vs. usual age onset status.
We identified 32,137 adults with new T2D, including 8,496 with early onset (26.4%, age 37.6 ± 5.3 years) and 23,641 with usual onset (73.6%, age 54.4 ± 5.5 years). Adults with early onset had a higher index A1c (A1c 8.9% vs. 8.4% for usual onset, p<0.001). Compared to usual onset, adults with early onset were more likely to initiate metformin (adjusted odds ratio [aOR] 1.20, 95% CI [1.12-1.27]), but less likely to receive a retinal exam (aOR 0.80, 95% CI [0.76-0.85]) or diabetes-related education (aOR 0.84, 95% CI [0.80-0.89]) during the first year of care. Adults with early onset were less likely to achieve goal glycemic control at one year following diagnosis (aOR 0.85, 95% CI [0.79-0.91]).
In conclusion, individuals with early onset T2D were less likely to achieve goal A1c (<7%) at one year following diagnosis. This suggests a need for tailored strategies to improve early T2D care for this high-risk population of adults presenting with T2D at younger ages.
M.A. Blatchins: None. P. Mishra: None. R.W. Grant: None. A. Gopalan: None.
National Institute of Diabetes and Digestive and Kidney Diseases