Cardiovascular complications and mortality in patients with youth-onset type 1 and type 2 diabetes: a population-based long-term follow-up study

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Introduction We compared the incidence density (ID) and hazards of ischaemic heart disease (IHD), heart failure (HF), stroke, composite cardiovascular disease (CVD), all-cause (ACM) and cardiovascular mortality (CVM) in a nationwide cohort of patients with youth-onset type 1 (T1D) and type 2 diabetes (T2D) with age of diabetes onset <40 years. Methods A total of 6059 patients with T1D (T1D <25 ) and 120 704 patients with T2D (T2D <25 ) with an age of diabetes onset <25 years and 1691 patients with T1D (T1D 25–39 ) and 378 070 patients with T2D (T2D 25–39 ) with an age of diabetes onset ≥25–39 years were linked to Taiwan’s National Health Insurance databases and Death Registry to identify IHD, HF, stroke, composite CVD, ACM and CVM. The person‒year approach and Cox proportional hazard regression model were used to determine the ID and hazards of cardiovascular-related study endpoints, with adjustments for age, sex, geographic area, medications and duration of diabetes. Results Patients with T1D <25 had the lowest ID, whereas those with T2D 25–39 had the greatest rates of cardiovascular outcomes. Compared with patients with T1D <25 , patients with T2D <25 had greater risks of IHD, HF, stroke and composite CVD (adjusted HRs (aHRs): 1.47, 1.86, 1.81 and 1.54, respectively). The aHRs of cardiovascular endpoints in patients with T2D <25 were greater than those in patients with T1D 25–39 but comparable to those in patients with T2D 25–39 . Patients with T2D <25 , T1D 25–39 and T2D 25–39 all had increased risks of ACM, but only patients with T2D 25–39 had elevated hazards of CVM compared with those of patients with T1D <25 . Conclusions Our findings highlight substantial heterogeneity in cardiovascular risk within youth-onset diabetes, particularly among patients with early-onset T2D <25 . Hazards of cardiovascular outcomes in patients with T2D <25 were greater than those in patients with T1D at any age of diabetes onset, and they were as high as those in patients with T2D 25–39 .

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