Copyright
©The Author(s) 2022.
World J Diabetes. Mar 15, 2022; 13(3): 260-271
Published online Mar 15, 2022. doi: 10.4239/wjd.v13.i3.260
Published online Mar 15, 2022. doi: 10.4239/wjd.v13.i3.260
Table 1 Summary of studies included in the pooled dataset
| Study name | Aim | Eligible age range (yr) | Exclusion criteria1 | Clinical Trials.gov Registration Number | Ongoing/completed |
| CODEC | Observational study to investigate the effect of chronotype on glycaemic controls in adults with T2DM | 18-75 | N/A | NCT02973412 | Ongoing |
| LYDIA | Randomised active-comparator trial to investigate the effect of liraglutide compared to sitagliptin on cardiac structure and function in younger adults with T2DM | 18-60 | Treatment with insulin, SGLT-2 inhibitors, GLP-1 receptor agonists of DPP-4 inhibitors; Active cardiovascular disease, including history of myocardial infarction within the past 6 mo and/or heart failure | NCT02043054 | Completed |
| EXPEDITION | Observational study to phenotype younger adults with T2DM | 18-40 | N/A | N/A | Completed |
| DIASTOLIC | Randomised controlled trial to compare diet and exercise interventions to standard care in adults with T2DM | 18-65 | Current treatment with more than three glucose-lowering medications or insulin; Stroke, peripheral vascular disease, atrial fibrillation, heart failure/disease, angina | NCT02590822 | Completed |
| PREDICT | Observational study to investigate the prevalence and determinants of subclinical cardiovascular dysfunction in adults with T2DM | 18-75 | Stroke, symptomatic peripheral vascular disease, atrial fibrillation, history of heart failure, history of myocardial infarction, moderate or severe heart valve disease, angina | NCT03132129 | Ongoing |
Table 2 Demographic characteristics, cardiovascular complications and medication use by age of diagnosis
| Age at T2DM diagnosis | Total sample (n = 1409) | |||
| Under 40 yr (n = 196) | 40-59 yr (n = 846) | 60 yr or over (n = 367) | ||
| Number of participants from each dataset, n (%) | ||||
| CODEC | 111 (56.6) | 636 (75.2) | 326 (88.8) | 1073 (76.2) |
| LYDIA | 35 (17.9) | 41 (4.9) | 0 (0.0) | 76 (5.4) |
| EXPEDITION | 20 (10.2) | 0 (0.0) | 0 (0.0) | 20 (1.4) |
| DIASTOLIC | 17 (8.7) | 72 (8.5) | 0 (0.0) | 89 (6.3) |
| PREDICT | 13 (6.6) | 97 (11.5) | 41 (11.2) | 151 (10.7) |
| Current age, yr (n = 1408) | 46 (38-55) | 61 (56-67) | 71 (68-73) | 63 (55-69) |
| Diabetes duration, yr (n = 1408) | 11 (5-21) | 10 (5-15) | 5 (3-8) | 8 (4-14) |
| Sex, n (%) | ||||
| Male | 100 (51.0) | 565 (66.8) | 243 (66.2) | 908 (64.4) |
| Female | 96 (49.0) | 281 (33.2) | 124 (33.8) | 501 (35.6) |
| Ethnicity, n (%) | ||||
| White | 125 (63.8) | 665 (78.6) | 333 (90.7) | 1123 (79.7) |
| Asian | 55 (28.1) | 145 (17.1) | 28 (7.6) | 228 (16.2) |
| Other | 6 (3.1) | 33 (3.9) | 5 (1.4) | 44 (3.1) |
| Unknown | 10 (5.1) | 3 (0.4) | 1 (0.3) | 14 (1.0) |
| Smoking status, n (%) | ||||
| Current smoker | 24 (12.2) | 66 (7.8) | 20 (5.5) | 110 (7.98) |
| Ex-smoker | 58 (29.6) | 367 (43.4) | 182 (49.6) | 607 (43.1) |
| Never smoked | 114 (58.2) | 413 (48.8) | 165 (45.0) | 692 (49.1) |
| Family history of T2D, n (%) | ||||
| Yes | 90 (45.9) | 326 (38.5) | 131 (35.7) | 547 (38.8) |
| No | 37 (18.9) | 264 (31.2) | 169 (46.1) | 470 (33.3) |
| Unknown | 69 (35.2) | 256 (30.3) | 67 (18.3) | 393 (27.9) |
| Cardiovascular complications, n (%) | ||||
| Myocardial infarction (n = 1233) | 7 (4.3) | 60 (8.0) | 36 (11.1) | 103 (8.4) |
| Heart failure (n = 1229) | 4 (2.5) | 12 (1.6) | 9 (2.8) | 25 (2.0) |
| Heart valve disease (n = 1228) | 3 (1.8) | 22 (3.0) | 11 (3.4) | 36 (2.9) |
| Atrial fibrillation (n = 1223) | 2 (1.2) | 42 (5.7) | 20 (6.2) | 64 (5.2) |
| Peripheral vascular disease (n = 1227) | 7 (4.4) | 43 (5.8) | 21 (6.5) | 71 (5.8) |
| Stroke (n = 1235) | 3 (1.9) | 31 (4.1) | 24 (7.4) | 58 (4.7) |
| Angina (n = 1230) | 5 (3.1) | 60 (8.1) | 33 (10.2) | 98 (8.0) |
| Glucose-lowering medication use, n (%) | ||||
| Any glucose-lowering medication (n = 1403) | 185 (94.9) | 753 (89.5) | 257 (70.0) | 1195 (85.2) |
| Insulin | 74 (37.8) | 178 (21.0) | 24 (6.5) | 276 (19.6) |
| Metformin (n = 1407) | 157 (80.1) | 658 (78.0) | 234 (63.8) | 1049 (74.6) |
| Sulphonylurias (n = 1407) | 36 (18.4) | 205 (24.3) | 51 (13.9) | 292 (20.8) |
| DPP-4 inhibitors | 18 (9.2) | 139 (16.4) | 39 (10.6) | 196 (13.9) |
| GLP-1 agonists | 33 (16.8) | 63 (7.5) | 9 (2.5) | 105 (7.5) |
| SGLT2 inhibitors (n = 1389) | 27 (17.0) | 89 (11.5) | 15 (4.1) | 131 (10.1) |
| Other1 (n = 1390) | 3 (1.9) | 19 (2.4) | 4 (1.1) | 26 (2.0) |
| Lipid-lowering medication use, n (%) | ||||
| Any lipid-lowering medication (n = 1407) | 112 (57.4) | 583 (69.0) | 254 (69.2) | 949 (67.5) |
| Statins (n = 1408) | 108 (55.4) | 580 (68.6) | 251 (68.4) | 939 (66.7) |
| Fibrates (n = 1407) | 10 (5.1) | 23 (2.7) | 4 (1.1) | 37 (2.6) |
| Antihypertensive medication use, n (%) | ||||
| Any antihypertensive medication (n = 1389) | 97 (54.8) | 582 (68.8) | 252 (68.9) | 931 (67.0) |
| ACE inhibitors (n = 1390) | 68 (38.4) | 356 (42.1) | 125 (34.1) | 549 (39.5) |
| Alpha blockers (n = 1388) | 8 (4.6) | 86 (10.2) | 53 (14.5) | 147 (10.6) |
| Angiotensin receptor blockers (n = 1389) | 17 (9.7) | 134 (15.8) | 61 (16.6) | 212 (15.3) |
| Beta blockers (n = 1388) | 20 (11.4) | 157 (18.6) | 70 (19.1) | 247 (17.8) |
| Calcium channel blockers (n = 1389) | 31 (17.6) | 246 (29.1) | 103 (28.1) | 380 (27.4) |
| Diuretics (n = 1389) | 25 (14.2) | 122 (14.4) | 58 (15.8) | 205 (14.8) |
| Metabolic syndrome prevalence, n (%)2 (n = 1290) | 159 (94.1) | 697 (90.2) | 298 (85.6) | 1154 (89.5) |
Table 3 Cardiovascular risk factors by age at diagnosis
| Age at T2DM diagnosis | Total sample (n = 1409) | |||
| Under 40 yr (n = 196) | 40-59 yr (n = 846) | 60 yr or over (n = 367) | ||
| Weight (kg) | 95.2 (82.5-108.9) | 92.0 (79.6-105.6) | 84.6 (73.7-97.4) | 90.6 (78.2-103.8) |
| BMI (kg/m2) | 33.0 (29.0-36.8) | 31.6 (28.0-35.3) | 29.2 (26.3-33.0) | 31.1 (27.5-35.0) |
| Waist circumference (cm), n = 1403 | 112.0 (102.2-119.1) | 109.0 (100.0-118.0) | 104.0 (96.8-113.5) | 108.0 (99.0-117.8) |
| Body fat (%), n = 1076 | 36.9 (29.5-44.5) | 34.0 (27.6-40.7) | 32.5 (26.3-41.0) | 33.8 (27.4-41.2) |
| HbA1c (%), n = 1370 | 7.5 (6.7-8.5) | 7.1 (6.4-7.9) | 6.5 (6.0-7.2) | 7.0 (6.3-7.8) |
| Total cholesterol (mmol/L), n = 1352 | 4.4 (3.8-5.2) | 4.2 (3.6-4.9) | 4.1 (3.5-4.8) | 4.2 (3.6-4.9) |
| LDL cholesterol (mmol/L), n = 1308 | 2.3 (1.8-2.9) | 2.1 (1.6-2.7) | 2.1 (1.6-2.6) | 2.1 (1.6-2.7) |
| HDL cholesterol (mmol/L), n = 1338 | 1.1 (1.0-1.4) | 1.2 (1.0-1.5) | 1.3 (1.1-1.5) | 1.2 (1.0-1.5) |
| Triglycerides (mmol/L), n = 1351 | 1.8 (1.2-2.7) | 1.7 (1.2-2.3) | 1.5 (1.1-2.1) | 1.6 (1.1-2.3) |
| Systolic blood pressure (mmHg), n = 1408 | 128.0 (119.0-140.0) | 135.0 (124.0-146.5) | 137.0 (125.5-148.7) | 135.0 (123.8-146.0) |
| Diastolic blood pressure (mmHg), n = 1408 | 83.0 (76.5-90.5) | 82.0 (76.0-89.0) | 79.5 (73.0-86.5) | 81.5 (75.0-88.6) |
Table 4 Results from linear regression models investigating the effect of age at diagnosis on each cardiovascular risk factor
| Model 1 | Model 2 | Model 3 | ||||
| Estimate | n | Estimate | n | Estimate | n | |
| Weight (kg) | -0.32 [(-0.51) to (-0.14)]a | 1409 | -0.45 [(-0.60) to (-0.31)]a | 1408 | -0.67 [(-0.82) to (-0.52)]a | 1394 |
| BMI (kg/m2) | -0.11 [(-0.19) to (-0.02)]b | 1409 | -0.15 [(-0.23) to (-0.07)]a | 1408 | -0.18 [(-0.25) to (-0.10)]a | 1394 |
| Waist circumference (cm) | -0.21 [(-0.32) to (-0.09)]a | 1403 | -0.23 [(-0.41) to (-0.05)]b | 1402 | -0.32 [(-0.49) to (-0.14)]a | 1388 |
| Body fat (%) | -0.10 (-0.80 to 0.60) | 1076 | -0.16 (-0.85 to 0.53) | 1075 | -0.11 (-0.43 to 0.20) | 1073 |
| HbA1c (%) | -0.04 [(-0.04) to (-0.03)]a | 1370 | -0.03 [(-0.04) to (-0.03)]a | 1369 | -0.03 [(-0.04) to (-0.03)]a | 1356 |
| Total cholesterol (mmol/L) | -0.01 (-0.01 to 0.00) | 1352 | -0.02 [(-0.02) to (-0.01)]a | 1351 | -0.01 [(-0.02) to (-0.01)]a | 1337 |
| LDL cholesterol (mmol/L) | -0.01 (-0.01 to 0.00)b | 1308 | -0.01 [(-0.02) to (-0.01)]a | 1307 | -0.01 [(-0.02) to (-0.01)]a | 1294 |
| HDL cholesterol (mmol/L) | 0.00 (0.00 to 0.01) | 1338 | 0.00 (0.00 to 0.01) | 1337 | 0.01 (0.00 to 0.01) | 1323 |
| Triglycerides (mmol/L) | -0.01 (-0.03 to 0.00) | 1351 | -0.02 [(-0.03) to (-0.01)]b | 1350 | -0.02 [(-0.03) to (-0.01)]a | 1336 |
| Systolic BP (mmHg) | 0.24 (0.14 to 0.35)a | 1408 | 0.31 (0.11 to 0.51)b | 1407 | 0.24 (0.02 to 0.45)b | 1393 |
| Diastolic BP (mmHg) | -0.10 (-0.21 to 0.02) | 1408 | -0.20 [(-0.29) to (-0.12)]a | 1407 | -0.22 [(-0.30) to (-0.14)]a | 1393 |
- Citation: Barker MM, Zaccardi F, Brady EM, Gulsin GS, Hall AP, Henson J, Htike ZZ, Khunti K, McCann GP, Redman EL, Webb DR, Wilmot EG, Yates T, Yeo J, Davies MJ, Sargeant JA. Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile: A pooled analysis. World J Diabetes 2022; 13(3): 260-271
- URL: https://www.wjgnet.com/1948-9358/full/v13/i3/260.htm
- DOI: https://dx.doi.org/10.4239/wjd.v13.i3.260