Type 2 diabetes is a serious condition that causes a person’s blood sugar levels to become too high, often leading to various health complications including damage to the kidney, heart and blood vessels (cardio-renal complications). Traditionally, type 2 diabetes used to occur in older adults; however, in recent years it has increasingly been diagnosed in younger adults. This has been termed early-onset type 2 diabetes, and includes the diagnosis of type 2 diabetes in adults up to 40 or 50 years of age. These younger adults are likely to have other health conditions alongside diabetes, such as obesity, high blood pressure and depression. Studies have also found that when type 2 diabetes is diagnosed at a younger age, the risk of heart and kidney complications and death is higher compared to older adults diagnosed with type 2 diabetes.
However, most of this research has been conducted outside the UK; therefore, we do not know how many younger adults have been diagnosed with early-onset type 2 diabetes, experienced co-occurring health conditions or diabetes-related complications or died with diabetes in the last two decades in this country. Therefore, we will do a study that investigates the following:
1. The change in number of younger adults diagnosed with early-onset type 2 diabetes between 2000 and the present day
2. The characteristics of young patients diagnosed with type 2 diabetes
3. The effect of age at type 2 diabetes diagnosis on the risk of experiencing co-occurring health conditions or death
Data from the Clinical Practice Research Datalink (CPRD, GOLD and Aurum), linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) data, will be used to investigate the following:
1. The characteristics of patients with early-onset type 2 diabetes at diagnosis and during disease trajectory - both cardiovascular risk factors (e.g. obesity, hypertension) and multimorbidity (cardio-renal outcomes, cancer, anxiety, depression)
2. The prevalence and incidence of early-onset type 2 diabetes between 2000 and the present day
3. The effect of age at type 2 diabetes diagnosis on the incidence of diabetes-associated complications (cardio-renal outcomes, cancer), all-cause and cause-specific mortality (cardiovascular, renal and cancer-related mortality)
Poisson regression models and survival models will be used in the analysis. Analyses will adjust for key covariates including age, sex, ethnicity and socioeconomic status. Ethnicity data will be provided by linkage to HES data and socioeconomic status data will be provided by the linkage to patient level IMD data.
• Prevalence and incidence of early-onset type 2 diabetes (Appendix 1 - medcodes, ICD-10 codes) (SNOMED codes will also be used in CPRD Aurum);
• Characteristics of patients with early-onset type 2 diabetes at diagnosis and during disease trajectory - both cardiovascular risk factors (e.g. obesity, hypertension) and multimorbidity (cardio-renal outcomes, cancer, anxiety, depression);
• Incidence of diabetes-related complications (cardio-renal outcomes, cancer) (Appendix 2-5 - medcodes and ICD-10
codes);
• All-cause and cause-specific deaths (cardiovascular, renal and cancer-related deaths)
Mary Barker - Chief Investigator - University of Leicester
Francesco Zaccardi - Corresponding Applicant - University of Leicester
Edward Gregg - Collaborator - Imperial College London
Eka Melson - Collaborator - University of Leicester
Jack Sargeant - Collaborator - University of Leicester
Jonathan Goldney Goldney - Collaborator - University of Leicester
Kamlesh Khunti - Collaborator - University of Leicester
Melanie Davies - Collaborator - University of Leicester
Mohammad Ali - Collaborator - University of Leicester
Yijing Chen - Collaborator - University of Leicester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation