Type 1 diabetes patients diagnosed at young age ‘have shorter life expectancy’

Patients who are diagnosed with type 1 diabetes at a young age have greater risk of heart problems and shorter life expectancy compared to those with a later diagnosis, a study has found.

Life expectancy for individuals with younger onset disease is on average 16 years shorter than people without diabetes, and 10 years shorter than those diagnosed at an older age, the findings published in The Lancet show.

With around half of individuals with type 1 diabetes diagnosed before the age of 14, the authors of the study said it highlights a need to consider wider and earlier use of cardioprotective measures such as statins and blood pressure lowering drugs for those affected.

Their findings suggest that individuals diagnosed before the age of 10 have a 30-times greater risk of serious cardiovascular outcomes such as heart attack and heart disease than those in the general population.

In comparison, risk levels are around six times higher for people diagnosed between the ages of 26 and 30.

They also found that patients with younger-onset type 1 diabetes are four times as likely to die from any cause and have more than seven times the risk of dying from cardiovascular disease than their diabetes-free counterparts.

In contrast, people first diagnosed between ages 26 and 30 face a lower risk of dying from any cause and cardiovascular disease compared with their peers without diabetes.

The authors said the impact of type 1 diabetes on younger people should not be underestimated, and there is a need to consider adding recommendations about the age of onset in future guidelines.

In the UK, there are around 400,000 people currently living with type 1 diabetes, with more than 29,000 of them children, according to the charity JDRF.

Study co-author Professor Naveed Sattar, of the University of Glasgow, said: “While the absolute risk levels are higher in individuals who develop diabetes when older, simply due to age being a strong risk factor, the excess risk compared to healthy controls is much higher in those who developed diabetes when younger.

“If this higher excess risk persists over time in such individuals, they would be expected to have highest absolute risks at any given subsequent age.

“Indeed, those who develop type 1 diabetes when under 10 years of age experience the greatest losses in life expectancy, compared to healthy controls.

“This is something we did not fully appreciate before.”

The large observational study followed more than 27,000 individuals in Sweden with type 1 diabetes and more than 135,000 matched controls for an average of 10 years.

It found 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.

Men with early onset type 1 diabetes die around 14 years earlier, while individuals diagnosed at 26 to 30 years old lose, on average, about 10 years of life.

Heart risks were also particularly pronounced in women, with those diagnosed before age 10 facing a 60-fold higher risk of heart disease and 90-times increased risk of heart attack than matched controls.

Men with young-onset diabetes have a 17 times greater risk of developing heart disease and 15 times higher risk of having a heart attack in early adulthood compared with those in the general population.

Prof Sattar added: “People with early onset diabetes should more often be considered for cardioprotective drugs such as statins and blood pressure lowering medication when they reach 30 to 40 years of age.

“Currently, only around 10-20% of individuals with type 1 diabetes are taking statins by the age of 40.”

Dr Araz Rawshani, from the University of Gothenburg, who co-led the research, said: “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.”