Early-onset diabetes: an epidemic in China

Abstract

Although type 2 diabetes is a disease often associated with aging, the global prevalence of early-onset diabetes has been increasing due to man’s sedentary lifestyle, low-physical activity, obesity, and some non-modifiable risk factors. Many studies have found that individuals with early-onset type 2 diabetes were at higher risk of developing vascular complications than those with late-onset diabetes. Individuals with early-onset diabetes are usually unwilling to visit hospital and have more confidence in their health, which results in poor glycemic control and the delayed detection of diabetes-related complications. Few studies have focused on the treatment and prevention of complications in specific population of individuals with early-onset type 2 diabetes. Therefore, focusing on this particular population is critical for the government and academic societies. Screening for T2DM is imminent for young adults with a family history of diabetes, obesity, markers of insulin resistance, or alcohol consumption. More data are definitely required to establish a reasonable risk model to screen for early-onset diabetes.

Keywords

diabetes / early-onset / diabetes complications

References

[1] Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G; 2010 China Noncommunicable Disease Surveillance Group.Prevalence and control of diabetes in Chinese adults. JAMA 2013; 310(9): 948–959

[2] Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 2009; 301(20): 2129–2140

[3] Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci 2013; 1281(1): 64–91

[4] Huo X, Gao L, Guo L, Xu W, Wang W, Zhi X, Li L, Ren Y, Qi X, Sun Z, Li W, Ji Q, Ran X, Su B, Hao C, Lu J, Guo X, Zhuo H, Zhang D, Pan C, Weng J, Hu D, Yang X, Ji L. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. Lancet Diabetes Endocrinol 2016; 4(2): 115–124

[5] Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, Li Y, Zhao Z, Qin X, Jin D, Zhou M, Tang X, Hu Y, Wang L. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA 2017; 317(24): 2515–2523

[6] Grinstein G, Muzumdar R, Aponte L, Vuguin P, Saenger P, DiMartino-Nardi J. Presentation and 5-year follow-up of type 2 diabetes mellitus in African-American and Caribbean-Hispanic adolescents. Horm Res 2003; 60(3): 121–126

[7] Harron KL, Feltbower RG, McKinney PA, Bodansky HJ, Campbell FM, Parslow RC. Rising rates of all types of diabetes in south Asian and non-south Asian children and young people aged 0–29 years in West Yorkshire, U.K., 1991–2006. Diabetes Care 2011; 34(3): 652–654

[8] Gunathilake W, Song S, Sridharan S, Fernando DJ, Idris I. Cardiovascular and metabolic risk profiles in young and old patients with type 2 diabetes. QJM 2010; 103(11): 881–884

[9] Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, Williams DE, Gregg EW, Bainbridge KE, Saydah SH, Geiss LS. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care 2009; 32(2): 287–294

[10] Chuang LM, Soegondo S, Soewondo P, Young-Seol K, Mohamed M, Dalisay E, Go R, Lee W, Tong-Yuan T, Tandhanand S, Nitiyanant W, The-Trach M, Cockram C, Jing-Ping Y. Comparisons of the outcomes on control, type of management and complications status in early onset and late onset type 2 diabetes in Asia. Diabetes Res Clin Pract 2006; 71(2): 146–155

[11] Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J; InterASIA Collaborative Group.Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia 2003; 46(9): 1190–1198

[12] Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J; China National Diabetes and Metabolic Disorders Study Group.Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362(12): 1090–1101

[13] Hsia Y, Neubert AC, Rani F, Viner RM, Hindmarsh PC, Wong IC. An increase in the prevalence of type 1 and 2 diabetes in children and adolescents: results from prescription data from a UK general practice database. Br J Clin Pharmacol 2009; 67(2): 242–249

[14] Haines L, Wan KC, Lynn R, Barrett TG, Shield JP. Rising incidence of type 2 diabetes in children in the U.K. Diabetes Care 2007; 30(5): 1097–1101

[15] Hillier TA, Pedula KL. Characteristics of an adult population with newly diagnosed type 2 diabetes: the relation of obesity and age of onset. Diabetes Care 2001; 24(9): 1522–1527

[16] Asia Pacific Cohort Studies Collaboration. The burden of overweight and obesity in the Asia-Pacific region. Obes Rev 2007; 8(3): 191–196

[17] Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK, He J; InterASIA Collaborative Group.Prevalence of the metabolic syndrome and overweight among adults in China. Lancet 2005; 365(9468): 1398–1405

[18] Popkin BM, Horton S, Kim S, Mahal A, Shuigao J. Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: the economic costs of the nutrition transition. Nutr Rev 2001; 59(12): 379–390

[19] Du S, Lu B, Zhai F, Popkin BM. A new stage of the nutrition transition in China. Public Health Nutr 2002; 5(1a 1A): 169–174

[20] Chan JC, Cheung CK, Swaminathan R, Nicholls MG, Cockram CS. Obesity, albuminuria and hypertension among Hong Kong Chinese with non-insulin-dependent diabetes mellitus (NIDDM). Postgrad Med J 1993; 69(809): 204–210 PMID: 8497435

[21] Dabelea D, DeGroat J, Sorrelman C, Glass M, Percy CA, Avery C, Hu D, D’Agostino RB Jr, Beyer J, Imperatore G, Testaverde L, Klingensmith G, Hamman RF; SEARCH for Diabetes in Youth Study Group. Diabetes in Navajo youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32(Suppl 2): S141–S147

[22] Bell RA, Mayer-Davis EJ, Beyer JW, D’Agostino RB Jr, Lawrence JM, Linder B, Liu LL, Marcovina SM, Rodriguez BL, Williams D, Dabelea D; SEARCH for Diabetes in Youth Study Group. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32(Suppl 2): S102–S111

[23] Liu LL,  Yi JP,  Beyer J,  Mayer-Davis EJ,  Dolan LM,  Dabelea DM,  Lawrence JM,  Rodriguez BL,  Marcovina SM,  Waitzfelder BE,  Fujimoto WY;  SEARCH for Diabetes in Youth Study Group. Type 1 and type 2 diabetes in Asian and Pacific Islander U.S. youth: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32(Suppl. 2): S133–140PMID: 19246578

[24] Okumiya K, Sakamoto R, Ishimoto Y, Kimura Y, Fukutomi E, Ishikawa M, Suwa K, Imai H, Chen W, Kato E, Nakatsuka M, Kasahara Y, Fujisawa M, Wada T, Wang H, Dai Q, Xu H, Qiao H, Ge RL, Norboo T, Tsering N, Kosaka Y, Nose M, Yamaguchi T, Tsukihara T, Ando K, Inamura T, Takeda S, Ishine M, Otsuka K, Matsubayashi K. Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland. BMJ Open 2016; 6(2): e009728

[25] Zou X, Zhou X, Ji L, Yang W, Lu J, Weng J, Jia W, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z. The characteristics of newly diagnosed adult early-onset diabetes: a population-based cross-sectional study. Sci Rep 2017; 7(1): 46534

[26] Jiang YD, Chang CH, Tai TY, Chen JF, Chuang LM. Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000–2009 Nationwide Health Insurance database. J Formos Med Assoc 2012; 111(11): 599–604

[27] Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993; 341(8850): 938–941

[28] Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008; 359(1): 61–73PMID:18596274

[29] Gluckman PD,  Hanson MA,  Buklijas T,  Low FM,  Beedle AS. Epigenetic mechanisms that underpin metabolic and cardiovascular diseases. Nat Rev Endocrinol 299; 5(7): 401–408 PMID: 19488075

[30] Li Y, He Y, Qi L, Jaddoe VW, Feskens EJ, Yang X, Ma G, Hu FB. Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes 2010; 59(10): 2400–2406

[31] Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, Roumain J, Bennett PH, Knowler WC. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 2000; 49(12): 2208–2211

[32] Tam WH, Ma RC, Yang X, Ko GT, Tong PC, Cockram CS, Sahota DS, Rogers MS, Chan JC. Glucose intolerance and cardiometabolic risk in children exposed to maternal gestational diabetes mellitus in utero. Pediatrics 2008; 122(6): 1229–1234

[33] Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25(10): 1862–1868

[34] Cieza-Borrella C, Díaz-Soto G, Martínez-Pino I, Puig-Domingo M, González-Sarmiento R. Early-onset type 2 diabetes mellitus is associated to HNF4A T130I polymorphism in families of central Spain. J Investig Med 2014; 62(8): 968–974

[35] Plengvidhya N, Boonyasrisawat W, Chongjaroen N, Jungtrakoon P, Sriussadaporn S, Vannaseang S, Banchuin N, Yenchitsomanus PT. Mutations of maturity-onset diabetes of the young (MODY) genes in Thais with early-onset type 2 diabetes mellitus. Clin Endocrinol (Oxf) 2009; 70(6): 847–853

[36] Domínguez-López A, Miliar-García A, Segura-Kato YX, Riba L, Esparza-López R, Ramírez-Jiménez S, Rodríguez-Torres M, Canizales-Quinteros S, Cabrera-Vásquez S, Fragoso-Ontiveros V, Aguilar-Salinas CA, Altamirano-Bustamante N, Calzada-León R, Robles-Valdés C, Bravo-Ríos LE, Tusié-Luna MT. Mutations in MODY genes are not common cause of early-onset type 2 diabetes in Mexican families. JOP 2005; 6(3): 238–245

[37] Zhou S, Meng X, Wang S, Ren R, Hou W, Huang K, Shi H. A 3-year follow-up study of b-cell function in patients with early-onset type 2 diabetes. Exp Ther Med 2016; 12(2): 1097–1102

[38] Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O,Davis M , Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977–986

[39] ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560–2572

[40] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352(9131): 837–853

[41] Amutha A, Anjana RM, Venkatesan U, Ranjani H, Unnikrishnan R, Venkat Narayan KM, Mohan V, Ali MK. Incidence of complications in young-onset diabetes: comparing type 2 with type 1 (the young diab study). Diabetes Res Clin Pract 2017; 123: 1–8

[42] Hessler DM, Fisher L, Mullan JT, Glasgow RE, Masharani U. Patient age: a neglected factor when considering disease management in adults with type 2 diabetes. Patient Educ Couns 2011; 85(2): 154–159

[43] Wong MCS, Kong APS, So WY, Jiang JY, Chan JCN, Griffiths SM. Adherence to oral hypoglycemic agents in 26,782 Chinese patients: a cohort study. J Clin Pharmacol 2011; 51(10): 1474–1482

[44] Yeung RO, Zhang Y, Luk A, Yang W, Sobrepena L, Yoon KH, Aravind SR, Sheu W, Nguyen TK, Ozaki R, Deerochanawong C, Tsang CC, Chan WB, Hong EG, Do TQ, Cheung Y, Brown N, Goh SY, Ma RC, Mukhopadhyay M, Ojha AK, Chakraborty S, Kong AP, Lau W, Jia W, Li W, Guo X, Bian R, Weng J, Ji L, Reyes-dela Rosa M, Toledo RM, Himathongkam T, Yoo SJ, Chow CC, Ho LL, Chuang LM, Tutino G, Tong PC, So WY, Wolthers T, Ko G, Lyubomirsky G, Chan JC. Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort. Lancet Diabetes Endocrinol 2014; 2(12): 935–943

[45] Avignon A, Attali C, Sultan A, Ferrat E, Le Breton J. Clinical inertia: viewpoints of general practitioners and diabetologists. Diabetes Metab 2012; 38(Suppl 3): S53–S58

[46] Kim KS, Oh HJ, Kim JW, Lee YK, Kim SK, Park SW, Kim YL, Park WK, Cho YW. The clinical characteristics of the newly diagnosed early onset (<40 years old) diabetes in outpatients’ clinic. Korean Diabetes J 2010; 34(2): 119–125

[47] Hatunic M, Burns N, Finucane F, Mannion C, Nolan JJ. Contrasting clinical and cardiovascular risk status between early and later onset type 2 diabetes. Diab Vasc Dis Res 2005; 2(2): 73–75

[48] Saydah S, Bullard KM, Imperatore G, Geiss L, Gregg EW. Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality. Pediatrics 2013; 131(3): e679–e686

[49] Li L, Ji L, Guo X, Ji Q, Gu W, Zhi X, Li X, Kuang H, Su B, Yan J, Yang X. Prevalence of microvascular diseases among tertiary care Chinese with early versus late onset of type 2 diabetes. J Diabetes Complications 2015; 29(1): 32–37

[50] Katulanda P, Waniganayake YC, Ranasinghe P, Wijetunga WU, Jayaweera M, Wijesinghe NP, Sheriff R, Matthews DR. Retinopathy among young adults with diabetes mellitus from a tertiary care setting in Sri Lanka. BMC Endocr Disord 2014; 14(1): 20

[51] Tryggestad JB, Willi SM. Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial. J Diabetes Complications 2015; 29(2): 307–312

[52] Sosale B, Sosale AR, Mohan AR, Kumar PM, Saboo B, Kandula S. Cardiovascular risk factors, micro and macrovascular complications at diagnosis in patients with young onset type 2 diabetes in India: CINDI 2. Indian J Endocrinol Metab 2016; 20(1): 114–118

[53] Rajalakshmi R, Amutha A, Ranjani H, Ali MK, Unnikrishnan R, Anjana RM, Narayan KM, Mohan V. Prevalence and risk factors for diabetic retinopathy in Asian Indians with young onset type 1 and type 2 diabetes. J Diabetes Complications 2014; 28(3): 291–297 doi:10.1016/j.jdiacomp.2013.12.008

[54] Bogdanović R. Diabetic nephropathy in children and adolescents. Pediatr Nephrol 2008; 23(4): 507–525

[55] Ruhayel SD, James RA, Ehtisham S, Cameron FJ, Werther GA, Sabin MA. An observational study of type 2 diabetes within a large Australian tertiary hospital pediatric diabetes service. Pediatr Diabetes 2010; 11(8): 544–551

[56] Eppens MC, Craig ME, Cusumano J, Hing S, Chan AK, Howard NJ, Silink M, Donaghue KC. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care 2006; 29(6): 1300–1306

[57] Scott A, Toomath R, Bouchier D, Bruce R, Crook N, Carroll D, Cutfield R, Dixon P, Doran J, Dunn P, Hotu C, Khant M, Lonsdale M, Lunt H, Wiltshire E, Wu D. First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders. N Z Med J 2006; 119(1235): U2015

[58] Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G, Linder B, Marcovina SM, Mayer-Davis EJ, Pettitt DJ, Rodriguez BL, Dabelea D. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care 2007; 30(10): 2593–2598

[59] Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman WP 3rd, Herderick EE, Cornhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281(8): 727–735

[60] Constantino MI, Molyneaux L, Limacher-Gisler F, Al-Saeed A, Luo C, Wu T, Twigg SM, Yue DK, Wong J. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care 2013; 36(12): 3863–3869PMID:23846814

[61] Chan JC, Lau ES, Luk AO, Cheung KK, Kong AP, Yu LW, Choi KC, Chow FC, Ozaki R, Brown N, Yang X, Bennett PH, Ma RC, So WY. Premature mortality and comorbidities in young-onset diabetes: a 7-year prospective analysis. Am J Med 2014; 127(7): 616–624

[62] Contreras-Rodríguez A, Gómez-Díaz RA, Tanus-Hajj J, Talavera JO, Mondragón-González R, Wacher NH. Carotid intima-media thickness, ankle-arm index, and inflammation profile in Mexican patients with early and late onset type 2 diabetes. Rev Invest Clin 2015; 67(4): 240–249

[63] Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med 2011; 171(5): 404–410

[64] TODAY Study Group, Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, Arslanian S, Cuttler L, Nathan DM, Tollefsen S, Wilfley D, Kaufman F. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 2012; 366(24): 2247–2256

[65] Jones KL, Arslanian S, Peterokova VA, Park JS, Tomlinson MJ. Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial. Diabetes Care 2002; 25(1): 89–94

[66] Gottschalk M, Danne T, Vlajnic A, Cara JF. Glimepiride versus metformin as monotherapy in pediatric patients with type 2 diabetes: a randomized, single-blind comparative study. Diabetes Care 2007; 30(4): 790–794

[67] Yan F, Cha E, Lee ET, Mayberry RM, Wang W, Umpierrez G. A self-assessment tool for screening young adults at risk of type 2 diabetes using Strong Heart Family Study Data. Diabetes Educ 2016; 42(5): 607–617

[68] Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué I Figuls M, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev 2008; 16(3): CD003054

[69] Merlotti C, Morabito A, Pontiroli AE. Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies. Diabetes Obes Metab 2014; 16(8): 719–727

[70] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393–403

[71] Amutha A, Mohan V. Diabetes complications in childhood and adolescent onset type 2 diabetes—a review. J Diabetes Complications 2016; 30(5): 951–957

[72] Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. Type 2 diabetes in children and adolescents. Pediatr Diabetes 2009; 10(Suppl 12): 17–32

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