Age at diabetes diagnosis was predictive of morbidity and mortality in older adults, according to data from a population-based, biennial longitudinal health interview survey.
Of 7,739 adults ages 50 and older who participated in the Health and Retirement Study survey, diabetes diagnosis at 50 to 59 years of age was significantly associated with mortality (HR 1.49, 95% CI 1.29-1.71) compared with no diabetes diagnosis, reported Judy Zhong, PhD, of NYU Grossman School of Medicine in New York City, and colleagues in JAMA Network Open.
This age group also saw significant associated risks for several comorbidities versus matched controls, including:
- Incident heart disease: HR 1.66 (95% CI 1.40-1.96)
- Stroke: HR 1.64 (95% CI 1.30-2.07)
- Disability: HR 2.08 (95% CI 1.59-2.72)
- Cognitive impairment: HR 1.30 (95% CI 1.05-1.61)
But when Zhong's group looked at adults diagnosed with diabetes just one decade older -- ages 60 to 69 -- these associated risks weren't quite as high, despite still being significant. This age group saw a 10% higher risk for death versus controls, as well as a 25% higher risk for incident heart disease, a 41% higher risk of stroke, and a 44% higher risk of disability, but no higher risk for cognitive impairment.
Furthermore, adults diagnosed with diabetes after their 70th birthday saw very few of these associated risks. This age group saw only an 8% higher risk for mortality and a 15% higher risk for heart disease. The other associations were not significant compared with control patients.
"The mechanisms that link earlier diabetes diagnosis to worse outcomes are not completely understood," the researchers noted. "The longer duration of diabetes in individuals with earlier diagnosis has been reported in several previous studies. In contrast, in our study, the age-at-diagnosis association persisted when diabetes duration was fully adjusted by comparing incident outcomes starting from the age at diabetes diagnosis."
They suggested one reason for these findings could be the fact that younger adults are being diagnosed with "a more physiologically aggressive form of diabetes, with worse glycemic control, beta cell dysfunction, insulin insufficiency, and insulin resistance," leading to worse outcomes.
Zhong and colleagues used data from participants in the Health and Retirement Study from 1995 to 2018, including 1,866 adults diagnosed with diabetes in their 50s, 2,834 diagnosed in their 60s, and 3,039 diagnosed in their 70s. They were matched with diabetes-free adults on several factors, including age, sex, BMI, lifestyle, baseline comorbidities, cognitive status, and more.
Diabetes and other outcomes assessed were self-reported. Disability was measured using self-reported activities of daily living and instrumental activities of daily living, such as walking across a room, dressing, bathing, eating, getting in and out of bed, using the toilet, using the telephone, managing money, taking medications, shopping, and preparing meals. Cognitive impairment was measured via a modified version of the Telephone Interview for Cognitive Status.
A higher percentage of women were diagnosed with diabetes than men across all age ranges. A greater proportion of Black and Hispanic adults were diagnosed in their 50s, with proportions dropping down as age increased. The opposite pattern was seen for white adults, however, as more diabetes diagnoses came later in life.
Disclosures
The study was supported by grants from the National Institute on Aging (NIA).
Zhong and co-authors reported relationships with the NIA, the Michigan Health Endowment Fund, the University of Michigan, the Veterans Affairs Office of Rural Health, and the Patient Safety Center.
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