A new study published in September’s issue of Diabetologia, entitled “Age and diabetes duration linked to risk of death and macro vascular complications, but only diabetes duration linked to risk of microvascular complications,” highlights the need for glycemic control early on among young people diagnosed with type 2 diabetes to minimize the risk of microvascular complications. Coauthors include Associate Professor Sophia Zoungas, The George Institute for Global Health, University of Sydney, NSW, Australia, and Professor Simon Heller, University of Sheffield, UK, among other colleagues.
Data concerning the associations between age, age at diagnosis of diabetes, diabetes duration, and subsequent vascular complications is still currently under debate in the research community.
To investigate their dependency, the authors designed a study with participants of a previous randomized regulated trial, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), with a wide representative group of people with established type 2 diabetes.
In the present study, the authors examined 11,140 patients with type 2 diabetes, randomly allocated to intensive or standard glucose control. The mean age of participants was 66 years; age at diagnosis was 59 years, and diabetes duration was 8 years.
When it came to macrovascular complications (those in larger blood vessels) the team found that for every 5 year increase in both age (or age at diagnosis) and duration of diabetes, there was an increase for multiple risks of macrovascular events and death.
The authors noted, “With respect to macrovascular complications, our findings from patients with type 2 diabetes indicate that effective prevention requires vigilance at all stages of the disease and across all age groups. However, as the absolute event rates were highest in the older age groups, surveillance for macrovascular complications should be intensified with increasing age.”
On the contrary, the risk for microvascular complications (smaller blood vessels) is linked solely with diabetes duration.
The implications of this study are quite substantial: younger people with diabetes have a higher risk of microvascular complications because they are more likely to have diabetes for longer over their lifetimes.
Regarding this, the authors said, “A refocus towards intensive management of hyperglycemia at diagnosis, particularly in younger people, may be warranted if the long-term risk of microvascular complications is to be minimised. With the increasing number of non-pharmacological and pharmacological approaches to improve glycaemic control this objective should be achievable.”
Finally, they concluded “In patients with type 2 diabetes, age or age at diagnosis of diabetes and diabetes duration are independently associated with the risk of macrovascular complications and death. By contrast, only diabetes duration is independently associated with the risk of microvascular complications, and the effects of diabetes duration are greatest at younger rather than older ages. Intensive glycaemic control of young people diagnosed with type 2 diabetes is warranted early to minimise the risk of microvascular complications.”