Burden of Chronic Conditions Heavier in Type 2 Diabetes

Liam Davenport

March 30, 2022

LONDON — Individuals with type 2 diabetes are at increased risk of developing a whole range of other chronic conditions that develop on average 5 years earlier than in those without the disease, reveals large-scale UK data.

Dr Luanluan Sun, DPhil, a clinical epidemiologist from the University of Cambridge, and colleagues studied around 3 million people aged 30 years or older from nationally representative databases, assessing the incidence of 116 chronic conditions.

Type 2 diabetes was significantly associated with 60 of the conditions, and affected individuals had a 28-42% increased risk of circulatory, genitourinary, neurological, and eye conditions. Crucially, these conditions developed on average 5 years earlier in people with type 2 diabetes than in those without, rising to 10 years earlier in people diagnosed with diabetes before age 50.

"Taking all this analysis together…individuals with diabetes experience other chronic outcomes at younger age compared with those without diabetes, and these differences are greater among those diagnosed earlier," Dr Sun said.

"Preventing or delaying the onset of diabetes remains essential to reduce diabetes-related health issues in middle age."

The research was presented at the Diabetes UK Professional Conference 2022 on March 29.

Need for 'Different Strategies' for Middle Age

Session chair Dr Anne Dornhorst, PhD, professor of practice, Centre for Endocrinology, Imperial College London, described the data as "absolutely fascinating". She said the study "really underlines the power of 'Big Data' and contemporary data".

"It’s just got so many important messages," Dr Dornhurst said, "especially around the increase in the burden of early onset type 2 diabetes, which is such a problem in England at the moment.

"It’s difficult to know how we can address it, and I think it’s very likely we’re going to need different strategies for this age group than older age groups."

"This study illustrates in alarming detail the unacceptable prevalence of poor health in middle-aged people with type 2 diabetes, and is a stark reminder of the extensive and serious long-term effects of diabetes on the body," commented, Elizabeth Robertson, PhD, director of research at Diabetes UK, in a release.

"Type 2 diabetes and the complications that can lead from it are not inevitable," she continued. "It's so important that people at increased risk of type 2 diabetes are supported to reduce their risk, and that those living with the condition have continued access to routine care and support to manage it well and avoid or delay complications."

Professor Jonathan Valabhji, OBE, the national clinical director for Diabetes and Obesity, NHS England, agreed, saying in a release the results are "a stark reminder of the wider implications of type 2 diabetes and obesity for individuals, and for the National Health Service".

By 2030, 1 in 10 UK Adults Will Have Type 2 Diabetes

Dr Sun began by noting that, worldwide, approximately 537 million adults were living with type 2 diabetes 2021, and it is projected that, by 2030, 1 in 10 UK adults will being living with the disease, while 1 in 3 will be at risk. It is already known that type 2 diabetes doubles the risk of all-cause mortality, shortening life expectancy by around 6 years. Around half of all deaths are attributable to vascular causes.

However, what is not clear, Dr Sun said, is how diabetes relates to a "wider range" of conditions "that commonly affect UK adults", including their age of onset. To find out, the team developed an initial list of 308 conditions that are "well-recorded, commonly observed" and take up "extensive resources" in the NHS. From these, they whittled it down to a list of 116 chronic, non-communicable conditions in 11 clinical groups, in which the condition primarily affects adults, is not viral or bacterial in nature, is not diagnosed only in individuals with diabetes, and lasts for at least 1 year.

They mined data on approximately 0.5 million adults aged 40-69 years from the UK Biobank and also examined routinely collected electronic health record data from the Clinical Practice Research Datalink, which covers approximately 2.5 million UK adults aged 30-89 years. The data from the two cohorts on individuals with no prior history of the 116 conditions were combined and linked to Hospital Episode Statistics and Office for National Statistics databases, as well as primary care data.

Type 2 Diabetes Related to 60 Incident Conditions

This revealed that type 2 diabetes was significantly associated, after Bonferroni correction, with 60 incident conditions. Among 31 circulatory conditions studied, patients had an increased risk of developing 23 of them.

Cox regression analysis revealed that, overall, individuals with type 2 diabetes had an increased risk of circulatory conditions, at a hazard ratio (HR) of 1.28, as well as gentiourinary conditions (HR=1.27), neurological conditions (HR=1.30), and eye conditions (HR=1.42).

Dr Sun said that, in terms of individual diseases, people with type 2 diabetes were five times more likely to develop end-stage kidney disease, four times more likely to have liver cancer, and three times more likely to develop macular degeneration. The results also showed that for all chronic conditions, the average age of onset among people with type 2 diabetes was 47 years, 5 years earlier than that in people without the disease. This translated into an average age of onset 6 years earlier for circulatory and neurological conditions, and 8 years earlier for genitourinary and eye conditions, Dr Sun said.

She also showed that greater differences in age at onset were observed in individuals diagnosed with type 2 diabetes at an earlier age, such that those diagnosed before age 50 years had an average onset of other chronic conditions "10 years earlier than their counterparts without diabetes".

The research was supported by the British Heart Foundation.

No relevant financial relationships declared.

Diabetes UK Professional Conference 2022: Abstract A19 (P139). Presented March 29.

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