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Title : 'A diabetes diagnosis lowers life expectancy.'
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'A diabetes diagnosis lowers life expectancy.'

"From The Lancet Diabetes and Endocrinology

Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

Introduction
The prevalence of type 2 diabetes is increasing globally, driven mainly by behavioural and societal factors related to obesity, nutrition, and physical activity.

In 2021, 537 million adults were estimated to have diabetes worldwide, with increasing numbers diagnosed at younger ages.

Previous estimates have suggested that adults with type 2 diabetes die, on average, 6 years earlier than their counterparts without diabetes. However, how this average reduction in life expectancy varies according to age at diagnosis is uncertain. Valid characterisation of this association requires prospective comparison of outcomes within the same cohorts of people with diabetes diagnosed at varying ages. However, few population cohorts have had sufficient statistical power, detail, and duration of follow-up to enable reliable estimation.

Moreover, previous modelling studies—which used state-transition models and life tables that rely on inputs from aggregated data—have considered diabetes only as a binary condition (i.e. absent or present) when estimating its effect on life expectancy. Few published studies have therefore directly analysed the association of age at diagnosis of diabetes with mortality and life expectancy.

We aimed to provide reliable estimates of the associations of age at diagnosis of diabetes with all-cause mortality, cause-specific mortality, and reductions in life expectancy in high-income countries. We analysed individual records from 97 long-term, prospective cohorts, involving 1 515 718 participants followed up for a total of 23·1 million person-years.

Summary

Background
The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

Methods
For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961–2007, median latest follow-up years 1980–2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

Findings
For participants with diabetes, we observed a linear dose–response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43–2·97) when diagnosed at 30–39 years, 2·26 (2·08–2·45) at 40–49 years, 1·84 (1·72–1·97) at 50–59 years, 1·57 (1·47–1·67) at 60–69 years, and 1·39 (1·29–1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women.

Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes.

Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

Interpretation
Every decade of earlier diagnosis of diabetes was associated with about 3–4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes."

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A few words on diabetes

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More than 29 million people in the United States have diabetes. That’s nearly 1 in 10 people, according to figures from the Centres for Disease Control and Prevention (CDC).

Most cases of the disease are type 2 diabetes — a condition in which the body doesn’t make enough insulin, uses insulin incorrectly, or both. This can cause high levels of sugar in the blood. People with type 2 diabetes must control this sugar, or blood glucose, with a combination of medications, like insulin, and lifestyle changes, such as diet and exercise. Diet is key to diabetes management.

Found in many foods such as breads, starches, fruits, and sweets, carbohydrate is the macronutrient that causes blood sugar levels to go up. Managing carbohydrate intake helps people manage their blood sugar.

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