Compared with patients who have onset type 2 diabetes (T2D) at a usual age, adults with young-onset T2D are hospitalized significantly more often in their lifetimes, according to study results published in Annals of Internal Medicine.
Researchers conducted this prospective cohort study to evaluate hospitalization rates among people with onset of T2D before age 40 (young-onset T2D) and to assess the effect of age at onset on hospitalization risk. The study included a population-based cohort (n = 422,908) and a registry-based cohort (n = 20,886) of adults with T2D (age 20 to 75).
Primary outcomes were all-cause and cause-specific hospitalization rates. Regression models were used to calculate estimated effect of age at T2D onset on hospitalization rate and cumulative bed-days from onset to age 75 years for young-onset T2D.
In both cohorts, patients with young-onset T2D had the highest hospitalization rates by attained age, and the registry cohort in particular had the steepest increases across the age range. Among these patients, 36.8% of bed-days before age 40 years were attributable to psychotic and mood disorders. Furthermore, adjusted rate ratios revealed increased rates of hospitalization in patients with young- vs usual-onset T2D (P <.001 for all):
- All-cause hospitalizations, 1.8 (95% CI, 1.7-2.0)
- Hospitalizations for renal causes, 6.7 (95% CI, 4.2-10.6)
- Diabetes hospitalizations, 3.7 (95% CI, 3.0-4.6)
- Cardiovascular hospitalizations, 2.1 (95% CI, 1.8-2.5)
- Hospitalizations for infection, 1.7 (95% CI, 1.4-2.1)
Using negative binomial regression, the researchers discovered that intensified control of modifiable risk factors (eg, normalized hemoglobin A1c, systolic blood pressure, and waist circumference) in patients with young-onset T2D was on average associated with a one-third decrease in cumulative bed-days from onset to age 75 years (97 to 65 bed-days).
Limitations of this study included possible cofounding, as well as potential bias in the registry study because of preferential selection of healthier patients with young-onset T2D.
The researchers said their results highlight “the evolution of hospitalization during the long course of [young-onset T2D], with an excess burden of serious mental illness in early adulthood and cardiorenal complications later in life. This costly burden is an urgent call for policymakers, payers, patients, and [healthcare] providers to take action and address this unmet need.”
Ke C, Lau E, Shah BR, et al. Excess burden of mental illness and hospitalization in young-onset type 2 diabetes: a population-based cohort study [published online January 15, 2019]. Ann Intern Med. doi:10.7326/M18-1900