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Is Poor Glucose Control and High Prevalence of Obesity Expected with Early-Onset T2D?

Mar 3, 2018

Study shows importance of clinical consciousness and assistance with disease management in individuals who were diagnosed with type 2 diabetes prior to age 45.

Rising trends in diagnosis of type 2 diabetes in early years of adulthood and even childhood have been observed over the past decade, especially in well-developed countries.  Individuals live with the disease for a greater number of years then they have in the past.  As a result, they are at risk for developing more aggressive macro- and microvascular complications.  Prior studies have explored above mentioned relationship, however, clear pattern of correlation between the age of T2D diagnosis and occurrence of certain risk factors have not been reported. Therefore, Bo and colleagues explored whether a high burden of clinical and behavioral risk factors are the main causes that lead to development of early-onset diabetes and if they are to blame for diabetes-related complications seen later on in life.


Cohort consisting of patients diagnosed with a new-onset of T2D was used to create a cross-sectional study that focused on differentiating between clinical and behavioral risk factors that are seen in subjects who have early-onset diabetes versus those with the late-onset. Patients newly diagnosed with diabetes were separated into study arms according to their age groups.  Subjects diagnosed prior to, or at the age of 45 were defined as having early-onset T2D.  Age between 56 to 65 served as a reference group as it is the age where majority of diabetes diagnoses are made.  individuals were labeled to have late-onset diabetes, if their diagnosis occurred after they have turned 75 years of age.   Prevalence of poor plasma glucose and HbA1c control, obesity, dyslipidemia, hypertension, and retinopathy were examined in each of the study groups as the clinical risk factors.  Amount of moderate-to-intensive physical activity, smoking, and alcohol intake were among the behavioral risk factors studied.  Finally, researchers examined the requirement for insulin treatment and the number of antihyperglycemic medications needed to manage T2DM to further investigate the risks of early-onset diabetes.

Researchers found that poor glucose control was greatest in the early-onset diabetes group. Overall, 12% of patients diagnosed before the age of 45 had poor A1c control compared to 7% in the reference and 1% in groups with late-onset diabetes, as shown with the prevalence ratio of 1.70.  Inversely, late-onset patients were most likely to have a good glucose control.  Similar gradient was established with other clinical factors as well: third of the patients in the early-onset group were diagnosed with hypertension and about half had hyperlipidemia.  Hospital-diagnosed retinopathy occurred in 7% of early-onset individuals and in 5% of subjects in the reference group. Early diagnosed patients had higher BMI ranges than did the reference or the late onset groups, for instance, 66% of patients in early-onset group had obesity, while 57% and 35% were in the reference and the late-onset groups, respectively.  Individuals diagnosed with diabetes prior to age of 45 were least likely to engage in a mild-to-moderate physical activity, but were most likely to smoke.  Less than 10 percent of all individuals in the study reported high-risk alcohol intake, furthermore, only 4% of patients with early-onset diabetes were high-risk drinkers matched to 7% of subjects in the reference group.  The greatest number of individuals with early-onset diabetes  (11%) needed combination therapies with insulin and other antidiabetic drugs to manage their glucose levels.

This number was reduced to 6% in the average age and to 2% in the late-onset group.

The results presented by Bo and colleagues prove the prevalence of poor glucose control, obesity, and inadequate health behavior to be greatest in persons who are diagnosed with diabetes prior to age of 45.  Given that the high occurrence of behavioral and clinical risk factors seen in younger adults may lead to serious macro- and microvascular complications later on in life, health practitioners need to work on cultivating clinical awareness in individuals with early-onset of diabetes.  Multifactorial interventions also need to be employed to diminish some of the aggressive events that can occur for this group of patients.   Considering the cross-sectional nature of the study conducted – particularly a risk of confounding bias that could have occurred in this study – prospective trials are needed to establish a clearer association between risk factors and complications seen with early-onset diabetes.

Practice Pearls:

  • Individuals diagnosed with diabetes prior to age of 45 have highest prevalence of poor glucose control and obesity.
  • Individuals with early-onset T2D are more likely to need dual therapy with insulin and non-insulin therapies for diabetes management.
  • In general, high prevalence of both behavioral and clinical risk factors are the main culprit that lead to younger age of diabetes diagnosis.


Anne Bo, et al. “Early-onset type 2 diabetes: Age gradient in clinical and behavioral risk factors in 5115 persons with newly diagnosed type 2 diabetes—Results from the DD2 study”. Diabetes Metabolism Research and Reviews. Dec 2017.  http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2968/abstract. Accessed on Jan 2018.

Lamija Zimic PharmD(c), University of South Florida College of Pharmacy