Item #6

Obesity a Risk for Early Onset of Type 2 Diabetes, Particularly 30-45 yr olds
Obesity increases 70% and so does diabetes

The greatest increase in obesity and type 2 diabetes in the United States is among young adults. Over the last decade, obesity in adults aged 20 to 29 years has increased 70%, while type 2 diabetes rose 70% in adults aged 30 to 39 years. The question arises: Are the metabolic profiles of these individuals different from older adults with type 2 diabetes?

      Hillier and Pedula reviewed the medical records of 2,437 patients who were diagnosed with type 2 diabetes between 1996 and 1998 and whose weight, HbA_1c, blood pressure, and lipid levels had been measured within 3 months of diagnosis. All patients were members of the Kaiser Permanente Northwest Division and had either early-onset diabetes (before age 45, n=277) or usual-onset diabetes (>45 years, n=2,160). 

      The authors noted an inverse linear relationship between body mass index (BMI) and age of type 2 diabetes diagnosis, with the early-onset group having a significantly higher BMI than the usual-onset group (39 compared with 33 kg/m², respectively, P<0.001). They stated, however, that all P values in the study should be viewed cautiously, since the results were not adjusted for multiple comparisons. 

      Compared with their counterparts, the early-onset group also had higher diastolic blood pressures (37% compared with 26%, P<0.001) and more abnormal lipid levels (82% compared with 78%, not significant). However, hypertension (defined as systolic blood pressure >130 mm Hg or diastolic blood pressure >85 mm Hg) was less prevalent in the early-onset group (49% compared with 61%, P<0.001). Hillier and Pedula noted that the prevalence of abnormal lipids and hypertension in these younger individuals suggest insulin resistance syndrome, which is associated with two to three times the risk of cardiovascular disease and a greater incidence of macrovascular complications.

 Although the early-onset group had lower LDL-C levels than their counterparts (77 compared with 91 mg/dL, respectively, P<0.001), their HDL-C levels were also lower (33 compared with 37 mg/dL, P<0.001). In addition, the TC:HDL-C ratio was significantly higher in the early-onset group (8.1 compared with 7.0, P<0.001). Mean total cholesterol and trigylceride levels were similar for both groups.

In multivariate analysis, the investigators found that BMI, female sex, cholesterol, diastolic and systolic blood pressure were all independently associated with early onset of type 2 diabetes. 

The authors concluded that a screening gap for type 2 diabetes in young adults exists. It is hoped that this study will help strengthen screening strategies in very obese young adults. They added that more research is needed to determine which young adults will benefit from screening and intervention for type 2 diabetes.
Hillier TA, Pedula KL. Characteristics of an adult population with newly diagnosed type 2 diabetes: the relation of obesity and age of onset. Diabetes Care. 2001; 24:1522-1527. 

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FACT:

Women must deal with additional risk factors—those that are associated with pregnancy and childbirth. Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. However, women who have had gestational diabetes are at an increased risk for developing type 2 diabetes later in life. In some studies, up to 40% of women with a history of gestational diabetes and obesity developed type 2 diabetes within 4 years of pregnancy.

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