Type 2 diabetes phenotype and progression is significantly different if diagnosed before versus after 65 years of age.
BACKGROUND
The incidence of type 2 diabetes is increasing disproportionately in individuals <65 years of age. It is not known whether disease characteristics in these younger patients are similar to "classic" late-onset type 2 diabetes.


METHODS
In the epidemiological cohort study entitled "Retrolective Study: Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes," a total of 3268 patients from randomly contacted primary care practices were documented during a mean follow-up period of 6.5 years. All newly diagnosed patients of these practices were included.


RESULTS
At diagnosis, 64.2% of the patients were aged < or =65 years. Thereof, 57.2% were male, whereas in the age group >65 years only 35.0% were male (p < 0.001). The younger group exhibited more severe metabolic deterioration at diagnosis and in the following years than the older group. Conversely, the older group presented at diagnosis with a higher prevalence of cardiovascular risk factors. Self-monitoring of blood glucose (SMBG) was more prominent in the younger group. In both age groups, the use of SMBG was associated with a significantly lower risk (p = 0.003) of a combined end point (severe diabetic complication or all-cause mortality).


CONCLUSIONS
There are considerable differences in disease characteristics between people diagnosed with type 2 diabetes during 45-65 years of age versus diagnosis at a later age. Type 2 diabetes diagnosed before the age of 65 years disproportionately affected men and exhibited a more severe disease course, but was characterized by significantly less cardiovascular risk factors in comparison to type 2 diabetes diagnosed at a later age. The use of SMBG was associated with a better clinical outcome in both age groups.
Hubert Kolb
German Diabetes Center, Institute for Clinical Diabetes Research, Düsseldorf, Germany.
Berthold Schneider
Lutz Heinemann
Tim Heise
Volker Lodwig
Jacques K Tshiang Tshiananga
Christian Weber
Werner A Scherbaum
Stephan Martin