Objective: To examine how T2D onset age affects A1C trajectory and A1C lowering with insulin and other drugs.

Methods: We conducted a cohort study (2000-16) in adults aged 18-75 years (y) with young-onset T2D (YOD; onset age <40 y) and usual-onset T2D (UOD; onset age ≥40 y). In the Hong Kong Diabetes Registry (n=21,016), we estimated the mean glycemic burden (area under curve of A1C over time) across the lifespan, stratifying by onset age. In the population-based Hong Kong Diabetes Surveillance Database (n=328,199), we examined the effect of onset age on A1C trajectory for incident T2D using linear mixed effects models, accounting for drugs using time-varying covariates. We followed for 10 y, censoring at death or insulin start. For those started on insulin (n=20,877), we used similar methods to examine the effect of time to insulin start on the post-insulin A1C trajectory.

Results: Glycemic burden was tripled in YOD versus UOD (38.8 versus 11.8 A1C-y). After accounting for drugs, YOD was associated with a higher baseline A1C (7.6%) and slope (0.05%/y) versus UOD (7.4%, 0.00%/y). Non-insulin drugs lowered A1C similarly across onset ages. The post-insulin A1C remained elevated for YOD, regardless of time to insulin start, but improved significantly for UOD.

Conclusions: YOD is associated with an aggressive A1C rise and excess glycemic burden despite insulin and other drugs. More effective strategies are needed to lower A1C in people with YOD.
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Disclosure

C. Ke: None. A. Luk: None. B.R. Shah: None. T. Stukel: None. E.S. Lau: None. R.C. Ma: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Pfizer Inc. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca. A.P. Kong: Advisory Panel; Self; Lilly Diabetes. Research Support; Self; AstraZeneca, Lilly Diabetes. Speaker's Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. E. Chow: Research Support; Self; Powder Pharmaceuticals Inc., Sanofi-Aventis. J.C. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare.

Funding

University of Toronto; Royal College of Physicians and Surgeons of Canada; Canadian Society of Endocrinology and Metabolism; Chinese University of Hong Kong; Asia Diabetes Foundation

© 2019 by the American Diabetes Association.
2019
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