title: Premature mortality and comorbidities in young-onset diabetes: a 7-year prospective analysis.
abstract: BACKGROUND
  There is an increasing prevalence of young-onset diabetes, especially in developing areas. We compared the clinical outcomes and predictors for cardiovascular-renal events between Chinese patients with type 2 diabetes with young- or late-onset of disease diagnosed before or after the age of 40 years, respectively.
  
  
  METHODS
  The Hong Kong Diabetes Registry was established in 1995 as an ongoing quality improvement initiative with consecutive enrollment of diabetic patients from ambulatory settings for documentation of risk factors, microvascular and macrovascular complications, and clinical outcomes using a structured protocol.
  
  
  RESULTS
  In 9509 Chinese patients with type 2 diabetes with a median (interquartile range) follow-up period of 7.5 (3.9-10.8) years, 21.3% (n = 2066) had young-onset diabetes. Despite 20 years difference in age, patients with young-onset diabetes (mean age, 41.3 years) had a similar or worse risk profile than those with late-onset disease (mean age, 61.9 years). Compared with the patients with late-onset diabetes, those with young-onset diabetes had lower rates of cardiovascular disease and chronic kidney disease for the same disease duration but a higher cumulative incidence of clinical events at any given age. With the use of stepwise Cox proportional hazard analysis, patients with young-onset diabetes had higher risks for cardiovascular and renal events when adjusted by age, but no difference in risks than in the patients with late-onset diabetes when further adjusted by disease duration.
  
  
  CONCLUSIONS
  Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong; Li Ka Shing Institute of Health Sciences, Hong Kong.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
authors.forename: Eric S H
authors.initials: ES
authors.lastname: Lau
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong. Electronic address: andrealuk@cuhk.edu.hk.
authors.forename: Andrea O Y
authors.initials: AO
authors.lastname: Luk
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
authors.forename: Kitty K T
authors.initials: KK
authors.lastname: Cheung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong.
authors.forename: Alice P S
authors.initials: AP
authors.lastname: Kong
authors.affiliation: Hospital Authority Headquarter, Hong Kong.
authors.forename: Linda W L
authors.initials: LW
authors.lastname: Yu
authors.affiliation: Nethersole School of Nursing, Public Health College, Tianjin Medical University, Tianjin, China.
authors.forename: Kai-Chow
authors.initials: KC
authors.lastname: Choi
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong.
authors.forename: Francis C C
authors.initials: FC
authors.lastname: Chow
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong.
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.affiliation: Asia Diabetes Foundation, Public Health College, Tianjin Medical University, Tianjin, China.
authors.forename: Nicola
authors.initials: N
authors.lastname: Brown
authors.affiliation: Department of Epidemiology, Public Health College, Tianjin Medical University, Tianjin, China.
authors.forename: Xilin
authors.initials: X
authors.lastname: Yang
authors.affiliation: National Institutes of Health, Phoenix, Ariz.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bennett
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong.
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong.
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Cardiovascular-renal events; Mortality; Young-onset diabetes