Calvin Ke1, Eric Lau2, Baiju R Shah3, Thérèse A Stukel4, Ronald C Ma2, Wing-Yee So2, Alice P Kong2, Elaine Chow2, Philip Clarke5, William Goggins2, Juliana C N Chan2, Andrea Luk2. 1. The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, and University of Toronto, Toronto, Ontario, Canada (C.K.). 2. The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong (E.L., R.C.M., W.S., A.P.K., E.C., W.G., J.C.C., A.L.). 3. University of Toronto, Institute for Clinical Evaluative Sciences, and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (B.R.S.). 4. University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (T.A.S.). 5. University of Melbourne, Melbourne, Victoria, Australia (P.C.).
Abstract
Background: Type 2 diabetes (T2D) increases hospitalization risk. Young-onset T2D (YOD) (defined as onset before age 40 years) is associated with excess morbidity and mortality, but its effect on hospitalizations is unknown. Objective: To determine hospitalization rates among persons with YOD and to examine the effect of age at onset on hospitalization risk. Design: Prospective cohort study. Setting: Hong Kong. Participants: Adults aged 20 to 75 years in population-based (2002 to 2014; n = 422 908) and registry-based (2000 to 2014; n = 20 886) T2D cohorts. Measurements: All-cause and cause-specific hospitalization rates. Negative binomial regression models estimated effect of age at onset on hospitalization rate and cumulative bed-days from onset to age 75 years for YOD. Results: Patients with YOD had the highest hospitalization rates by attained age. In the registry cohort, 36.8% of YOD bed-days before age 40 years were due to mental illness. The adjusted rate ratios showed increased hospitalization in YOD versus usual-onset T2D (onset at age ≥40 years) (all-cause, 1.8 [95% CI, 1.7 to 2.0]; renal, 6.7 [CI, 4.2 to 10.6]; diabetes, 3.7 [CI, 3.0 to 4.6]; cardiovascular, 2.1 [CI, 1.8 to 2.5]; infection, 1.7 [CI, 1.4 to 2.1]; P < 0.001 for all). Models estimated that intensified risk factor control in YOD (hemoglobin A1c level <6.2%, systolic blood pressure <120 mm Hg, low-density lipoprotein cholesterol level <2.0 mmol/L [<77.3 mg/dL], triglyceride level <1.3 mmol/L [<115.1 mg/dL], waist circumference of 85 cm [men] or 80 cm [women], and smoking cessation) was associated with a one-third reduction in cumulative bed-days from onset to age 75 years (97 to 65 bed-days). Limitation: Possible residual confounding. Conclusion: Adults with YOD have excess hospitalizations across their lifespan compared with persons with usual-onset T2D, including an unexpectedly large burden of mental illness in young adulthood. Efforts to prevent YOD and intensify cardiometabolic risk factor control while focusing on mental health are urgently needed. Primary Funding Source: Asia Diabetes Foundation.
Background: Type 2 diabetes (T2D) increases hospitalization risk. Young-onset T2D (YOD) (defined as onset before age 40 years) is associated with excess morbidity and mortality, but its effect on hospitalizations is unknown. Objective: To determine hospitalization rates among persons with YOD and to examine the effect of age at onset on hospitalization risk. Design: Prospective cohort study. Setting: Hong Kong. Participants: Adults aged 20 to 75 years in population-based (2002 to 2014; n = 422 908) and registry-based (2000 to 2014; n = 20 886) T2D cohorts. Measurements: All-cause and cause-specific hospitalization rates. Negative binomial regression models estimated effect of age at onset on hospitalization rate and cumulative bed-days from onset to age 75 years for YOD. Results:Patients with YOD had the highest hospitalization rates by attained age. In the registry cohort, 36.8% of YOD bed-days before age 40 years were due to mental illness. The adjusted rate ratios showed increased hospitalization in YOD versus usual-onset T2D (onset at age ≥40 years) (all-cause, 1.8 [95% CI, 1.7 to 2.0]; renal, 6.7 [CI, 4.2 to 10.6]; diabetes, 3.7 [CI, 3.0 to 4.6]; cardiovascular, 2.1 [CI, 1.8 to 2.5]; infection, 1.7 [CI, 1.4 to 2.1]; P < 0.001 for all). Models estimated that intensified risk factor control in YOD (hemoglobin A1c level <6.2%, systolic blood pressure <120 mm Hg, low-density lipoprotein cholesterol level <2.0 mmol/L [<77.3 mg/dL], triglyceride level <1.3 mmol/L [<115.1 mg/dL], waist circumference of 85 cm [men] or 80 cm [women], and smoking cessation) was associated with a one-third reduction in cumulative bed-days from onset to age 75 years (97 to 65 bed-days). Limitation: Possible residual confounding. Conclusion: Adults with YOD have excess hospitalizations across their lifespan compared with persons with usual-onset T2D, including an unexpectedly large burden of mental illness in young adulthood. Efforts to prevent YOD and intensify cardiometabolic risk factor control while focusing on mental health are urgently needed. Primary Funding Source: Asia Diabetes Foundation.
Authors: John Dibato; Olga Montvida; Joanna Ling; Digsu Koye; William H Polonsky; Sanjoy K Paul Journal: Diabetologia Date: 2022-09-05 Impact factor: 10.460
Authors: Johnny T K Cheung; Eric Lau; Cyrus C T Tsui; Edmond L N Siu; Naomi K W Tse; Nicole Y L Hui; Ronald C W Ma; Alice P S Kong; Amy Fu; Vanessa Lau; Weiping Jia; Wayne H H Sheu; Leorino Sobrepena; K H Yoon; Alexander T B Tan; Yook-Chin Chia; Aravind Sosale; Banshi D Saboo; Jothydev Kesavadev; Su-Yen Goh; Thy Khue Nguyen; Yotsapon Thewjitcharoen; Raymond Suwita; Andrea O Y Luk; Aimin Yang; Elaine Chow; Lee Ling Lim; Juliana C N Chan Journal: BMC Med Date: 2022-07-14 Impact factor: 11.150
Authors: Aimin Yang; Hongjiang Wu; Eric S H Lau; Xinge Zhang; Mai Shi; Baoqi Fan; Ronald C W Ma; Alice P S Kong; Andrea O Y Luk; Juliana C N Chan; Elaine Chow Journal: Lancet Reg Health West Pac Date: 2022-06-24
Authors: Hongjiang Wu; Eric S H Lau; Ronald C W Ma; Alice P S Kong; Sarah H Wild; William Goggins; Elaine Chow; Wing-Yee So; Juliana C N Chan; Andrea O Y Luk Journal: Diabetologia Date: 2020-01-16 Impact factor: 10.122
Authors: Hongjiang Wu; Eric S H Lau; Aimin Yang; Baoqi Fan; Ronald C W Ma; Alice P S Kong; Elaine Chow; Wing-Yee So; Juliana C N Chan; Andrea O Y Luk Journal: Diabetologia Date: 2021-06-14 Impact factor: 10.122
Authors: Hongjiang Wu; Eric S H Lau; Aimin Yang; Ronald C W Ma; Alice P S Kong; Elaine Chow; Wing-Yee So; Juliana C N Chan; Andrea O Y Luk Journal: Cardiovasc Diabetol Date: 2020-05-12 Impact factor: 9.951
Authors: Carlos K H Wong; Kenneth K C Man; Esther W Y Chan; Tingting Wu; Emily T Y Tse; Ian C K Wong; Cindy L K Lam Journal: BMJ Open Diabetes Res Care Date: 2020-06
Authors: Hongjiang Wu; Eric S H Lau; Aimin Yang; Cheuk-Chun Szeto; Ronald C W Ma; Alice P S Kong; Elaine Chow; Wing-Yee So; Juliana C N Chan; Andrea O Y Luk Journal: Lancet Reg Health West Pac Date: 2021-06-09