Anjali Gopalan1, Pranita Mishra2, Stacey E Alexeeff2, Maruta A Blatchins2, Eileen Kim3, Alan Man4, Andrew J Karter2, Richard W Grant2. 1. Division of Research, Kaiser Permanente Northern California, Oakland, CA anjali.gopalan@kp.org. 2. Division of Research, Kaiser Permanente Northern California, Oakland, CA. 3. Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA. 4. Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, CA.
Abstract
OBJECTIVE: The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year. RESULTS: Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]). CONCLUSIONS: Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.
OBJECTIVE: The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year. RESULTS: Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]). CONCLUSIONS: Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.
Authors: Elaine C Khoong; Gem M Le; Mekhala Hoskote; Natalie A Rivadeneira; Robert A Hiatt; Urmimala Sarkar Journal: Med Care Date: 2019-06 Impact factor: 2.983
Authors: Kristin L Schneider; Christopher Andrews; Kathleen M Hovey; Rebecca A Seguin; Todd Manini; Michael J Lamonte; Karen L Margolis; Molly E Waring; Yi Ning; Stacy Sims; Yunsheng Ma; Judith Ockene; Marcia L Stefanick; Sherry L Pagoto Journal: Med Sci Sports Exerc Date: 2014-01 Impact factor: 5.411
Authors: Imad M El-Kebbi; Curtiss B Cook; David C Ziemer; Christopher D Miller; Daniel L Gallina; Lawrence S Phillips Journal: Arch Intern Med Date: 2003-01-13
Authors: Richard W Grant; Julie A Schmittdiel; Romain S Neugebauer; Connie S Uratsu; Barbara Sternfeld Journal: J Gen Intern Med Date: 2013-12-06 Impact factor: 5.128
Authors: Neda Laiteerapong; Sandra A Ham; Yue Gao; Howard H Moffet; Jennifer Y Liu; Elbert S Huang; Andrew J Karter Journal: Diabetes Care Date: 2018-08-13 Impact factor: 17.152
Authors: Katherine E Goodman; Laurence S Magder; Jonathan D Baghdadi; Lisa Pineles; Andrea R Levine; Eli N Perencevich; Anthony D Harris Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 9.079
Authors: Sasini Wijayaratna; Arier Lee; Hyun Young Park; Emmanuel Jo; Fiona Wu; Warwick Bagg; Tim Cundy Journal: BMJ Open Diabetes Res Care Date: 2021-12
Authors: Shivani Misra; David Gable; Kamlesh Khunti; Emma Barron; Bob Young; Partha Kar; Jonathan Valabhji Journal: Diabet Med Date: 2022-08-23 Impact factor: 4.213