title: Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort.
abstract: BACKGROUND
  The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort.
  
  
  METHODS
  JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants' first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes.
  
  
  RESULTS
  Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41,029 patients (15,341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years [SD 5·7] versus 53·9 years [9·0] with late-onset diabetes (n=33,548). Those with young-onset diabetes had longer disease duration (median 10 years [IQR 3-18]) than those with late-onset diabetes (5 years [2-11]). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%; p<0·0001) Patients with young-onset diabetes had higher mean concentrations of HbA1c (mean 8·32% [SD 2·03] vs 7·69% [1·82]; p<0·0001), LDL cholesterol (2·78 mmol/L [0·96] vs 2·74 [0·93]; p=0·009), and a higher prevalence of retinopathy (1363 [20%] vs 5714 (18%); p=0·011) than those with late-onset diabetes, but were less likely to receive statins (2347 [31%] vs 12,441 [37%]; p<0·0001) and renin-angiotensin-system inhibitors (1868 [25%] vs 9665 [29%]; p=0·006).
  
  
  CONCLUSIONS
  In clinic-based settings across Asia, one in five adult patients had young-onset diabetes. Compared with patients with late-onset diabetes, metabolic control in those with young-onset diabetes was poor, and fewer received organ-protective drugs. Given the risk conferred by long-term suboptimum metabolic control, our findings suggest an impending epidemic of young-onset diabetic complications.
  
  
  BACKGROUND
  The Asia Diabetes Foundation (ADF) and Merck.
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Roseanne O
authors: RO
authors: Yeung
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Yuying
authors: Y
authors: Zhang
authors: Prince of Wales Hospital, Hong Kong, China.
authors: Andrea
authors: A
authors: Luk
authors: China-Japan Friendship Hospital, Beijing, China.
authors: Wenying
authors: W
authors: Yang
authors: Heart of Jesus Hospital, San Jose City, Philippines.
authors: Leorino
authors: L
authors: Sobrepena
authors: The Catholic University of Korea, Seoul, South Korea.
authors: Kun-Ho
authors: KH
authors: Yoon
authors: Diacon Hospital, Bangalore, India.
authors: S R
authors: SR
authors: Aravind
authors: Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Wayne
authors: W
authors: Sheu
authors: HCMC University of Pharmaceutical and Medicine, Ho Chi Mihn City, Vietnam.
authors: Thy Khue
authors: TK
authors: Nguyen
authors: Prince of Wales Hospital, Hong Kong, China.
authors: Risa
authors: R
authors: Ozaki
authors: Rajavithi Hospital, Bangkok, Thailand.
authors: Chaicharn
authors: C
authors: Deerochanawong
authors: Alice Ho Nethersole Hospital, Hong Kong, China.
authors: Chiu Chi
authors: CC
authors: Tsang
authors: Qualigenics Diabetes Centre, Hong Kong, Hong Kong SAR.
authors: Wing-Bun
authors: WB
authors: Chan
authors: Hallym University College of Medicine, Seoul, South Korea.
authors: Eun Gyoung
authors: EG
authors: Hong
authors: Bach Mai Hospital, Hanoi, Vietnam.
authors: Trung Quan
authors: TQ
authors: Do
authors: Ma On Shan Family Medicine Centre, Hong Kong, China.
authors: Yu
authors: Y
authors: Cheung
authors: Asia Diabetes Foundation, Hong Kong, China.
authors: Nicola
authors: N
authors: Brown
authors: Singapore General Hospital, Singapore.
authors: Su Yen
authors: SY
authors: Goh
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Ronald C
authors: RC
authors: Ma
authors: Dr M K Mukhopadhyay's Diabetic Clinic, Kolkata, India.
authors: Monojitketan
authors: M
authors: Mukhopadhyay
authors: ILS Hospital, Kolkata, India.
authors: Arvind Kumar
authors: AK
authors: Ojha
authors: Seth Sukhlal Karnani Memorial Hospital, India.
authors: Shaibal
authors: S
authors: Chakraborty
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Alice P
authors: AP
authors: Kong
authors: Prince of Wales Hospital, Hong Kong, China.
authors: Winnie
authors: W
authors: Lau
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Weiping
authors: W
authors: Jia
authors: Peking Union Medical College Hospital, Beijing, China.
authors: Wenhui
authors: W
authors: Li
authors: Peking Union Medical College Hospital, Beijing, China.
authors: Xiaohui
authors: X
authors: Guo
authors: Jiangsu Province Hospital, Nanjing, China.
authors: Rongwen
authors: R
authors: Bian
authors: The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Jianping
authors: J
authors: Weng
authors: Peking University People's Hospital, Beijing, China.
authors: Linong
authors: L
authors: Ji
authors: Tondo Hospital, Manila, Philippines.
authors: Mercedes
authors: M
authors: Reyes-dela Rosa
authors: Senor St Nino Hospital, Camiling, Philippines.
authors: Ronaldo M
authors: RM
authors: Toledo
authors: Theptarin Hospital, Bangkok, Thailand.
authors: Thep
authors: T
authors: Himathongkam
authors: The Catholic University Bucheon St Mary's Hospital, Bucheon, South Korea.
authors: Soon-Jib
authors: SJ
authors: Yoo
authors: Prince of Wales Hospital, Hong Kong, China.
authors: C C
authors: CC
authors: Chow
authors: Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors: Larry L T
authors: LL
authors: Ho
authors: National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Lee-Ming
authors: LM
authors: Chuang
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Greg
authors: G
authors: Tutino
authors: Qualigenics Diabetes Centre, Hong Kong, China.
authors: Peter C
authors: PC
authors: Tong
authors: Prince of Wales Hospital, Hong Kong, China.
authors: Wing-Yee
authors: WY
authors: So
authors: Asia Diabetes Foundation, Hong Kong, China.
authors: Troels
authors: T
authors: Wolthers
authors: The Chinese University of Hong Kong, Hong Kong, China.
authors: Gary
authors: G
authors: Ko
authors: Asia Diabetes Foundation, Hong Kong, China.
authors: Greg
authors: G
authors: Lyubomirsky
authors: The Chinese University of Hong Kong, Hong Kong, China. Electronic address: jchan@cuhk.edu.hk.
authors: Juliana C N
authors: JC
authors: Chan
mesh_terms: D000328:Adult; D000367:Age Factors; D001208:Asia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D058872:Epidemics; D005260:Female; D006801:Humans; D008297:Male; D055442:Metabolome; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors