The Lancet: Early age of type 1 diabetes diagnosis linked to greater heart risks and shorter life expectancy, compared to later diagnosis

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Life-expectancy for individuals with younger-onset disease is on average 16 years shorter compared to people without diabetes, and 10 years shorter for those diagnosed at an older age.Being diagnosed with type 1 diabetes at a young age is associated with more cardiovascular complications and higher risk of premature death than being diagnosed later in life, independent of disease duration. The findings, published in The Lancet, come from a large observational study in Sweden that followed over 27,000 individuals with type 1 diabetes and more than 135,000 matched controls for an average of 10 years.

              With around half of individuals with type 1 diabetes diagnosed before the age of 14, the authors stress the need to consider wider and earlier use of cardioprotective measures such as statins and blood pressure lowering drugs in this high-risk population."Although the relative risk of cardiovascular disease is increased after an early diabetes diagnosis, the absolute risk is low", says Dr Araz Rawshani from the University of Gothenburg in Sweden who co-led the research. "However, age at disease onset appears to be an important determinant of survival as well as cardiovascular outcomes in early adulthood, warranting consideration of earlier treatment with cardioprotective drugs."[1]

               The new estimates suggest that individuals diagnosed before the age of 10 have a 30-times greater risk of serious cardiovascular outcomes like heart attack (0.31 cases per 100,000 person years for participants with diabetes vs 0.02 cases in every 100,000 person-years for controls) and heart disease (0.5 vs 0.03) than those in the general population, whilst risk levels are around six times higher for people diagnosed between ages 26 and 30 (0.87 vs 0.25 and 1.80 vs 0.46 respectively).People with younger-onset type 1 diabetes are four times as likely to die from any cause (0.61 vs 0.17), and have more than seven times the risk of dying from cardiovascular disease (0.09 vs 0.02) than their diabetes-free counterparts. In contrast, people first diagnosed between ages 26 and 30 face a lower (three-fold) risk of dying from any cause (1.9 vs 0.6) and cardiovascular disease (0.56 vs 0.15) compared to their peers without diabetes.

      Type 1 diabetes mellitus is the second most common chronic disease in children, accounting for 85% of diabetes in the under 20s. But it's not unusual to develop the disease as an adult. Worldwide, the incidence of type 1 diabetes in children aged 14 years and younger has risen by 3% a year since the 1980s.It's well known that people with type 1 diabetes are at increased risk of health problems and have shorter life expectancies, partly due to premature cardiovascular disease. But, until now, the impact of age of diagnosis on this excess mortality and cardiovascular risk was unclear.

These estimates for early-onset disease are substantially higher than recent estimates by the American Heart Association and American Diabetes Association, which do not consider age of onset as a risk stratifier, and report that women with type 1 diabetes are at seven times increased risk and men at three times the risk of developing heart disease.

Life expectancy was also markedly shorter for women with type 1 diabetes. Women who develop the condition before 10 years of age die on average around 18 years earlier than their diabetes-free counterparts (average life expectancy 70.9 years vs 88.6 years), whilst men with early onset type 1 diabetes die around 14 years earlier (69.1 years vs 83.3 years). Individuals diagnosed at 26-30 years old lose, on average, about 10 years of life.