Recent research has suggested that the lifespan of people diagnosed with type 2 diabetes by the age of 30 is 14 years less than those without diabetes, while a second study found that the injectable diabetes treatment tirzepatide, (Mounjaro), is as effective in those with early-onset diabetes as it is in those who develop it later in life.
The first study, published in The Lancet Diabetes & Endocrinology, which examined the effect of a type 2 diabetes diagnosis on life expectancy, found that being diagnosed with the condition shortened life expectancy by an average of six years.
However, if that diagnosis were at the age of 30, life expectancy was reduced by 14 years.
In more promising news, another study found that tirzepatide, the injectable diabetes drug known as Mounjaro, is as effective in those with early-onset type 2 diabetes as it is in people who develop it later in life.
Both papers were presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany.
Reduced life expectancy
In the first study, scientists used data from two large-scale sources – the Emerging Risk Factors Collaboration and the UK Biobank – and found that for every decade earlier that type 2 diabetes was diagnosed, life expectancy was reduced by three to four years.
One of the authors, Professor Naveed Sattar from the Institute of Cardiovascular & Medical Sciences, University of Glasgow, said: “Our findings support the idea that the younger an individual is when they develop type 2 diabetes, the more damage their body accumulates from its impaired metabolism.”
However, he added: “The findings also suggest that early detection of diabetes by screening, followed by intensive glucose management, could help prevent long-term complications from the condition.”
“Diabetes, if not well managed, can lead to multiple complications, such as kidney failure, heart disease and amputations, each of which lower life expectancy,” Dr Robert Gabbay, chief scientific and medical officer for the American Diabetes Association, who was not involved in the study, told Medical News Today.
In the United States, compared with a person without diabetes, a 50-year-old with diabetes died on average 14 years earlier if diagnosed at the age of 30, 10 years earlier when diagnosed at 40, or six years earlier when diagnosed at 50.
Corresponding estimates for the European Union were 13, nine, or five years earlier.
Mounjaro for treating early diabetes
Another study proffered potential good news for those with early-onset type 2 diabetes.
Researchers found that tirzepatide (Mounjaro), one of the new class of drugs that mimic the effect of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) – two hormones involved in blood sugar control and appetite suppression – is as effective in those with early-onset type 2 diabetes as in people who develop the disease later.
The drug, given by once-weekly injection, was approved by the FDA in the US in May 2022 and in the United Kingdom for “difficult to manage type 2 diabetes” last month.
In this study, researchers from the University of Leicester, UK, and the US assessed the effect of tirzepatide on blood glucose control, body weight and cardiometabolic markers in young and later-onset type 2 diabetes.
They used data from the SURPASS programme (SURPASS-1, -2, -3 and -5) for three different doses of tirzepatide: 5mg, 10mg, and 15mg.
They found that tirzepatide was equally effective at all three doses in both groups. Both groups showed improved average blood glucose levels and weight after 40 or 52 weeks.
Other improvements included: waist circumference; lipids and systolic blood pressure.
Risks of early-onset T2D
Type 2 diabetes that is diagnosed in childhood or early adulthood (under 40) is classified as early-onset type 2 diabetes.
It is generally more aggressive and harder to treat than type 2 diabetes diagnosed later in life. It raises the risk of cardiovascular disease, early death, and microvascular complications from raised blood glucose, which can lead to:
• Retinopathy: Blood vessels in the retina become damaged, which can lead to blindness.
• Neuropathy: Nerve damage resulting from lack of blood supply in the small vessels leading to nerves.
• Nephropathy: Kidney damage that prevents the kidneys from filtering blood properly, leading to a build-up of wastes in the body.
“Early-onset type 2 diabetes is not only more aggressive, it usually responds less well to drugs, which means our findings are really encouraging.
“Further research is now needed to evaluate whether starting treatment with tirzepatide and similar drugs early improves long-term outcomes in this important group,” said Professor Melanie Davies, corresponding author, University of Leicester.
Study details
Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23m person-years of observation
The Emerging Risks Collaboration
Published in The Lancet in October 2023
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.
Study 2 details
Efficacy and Safety of Tirzepatide in Type 2 Diabetes and Obesity Management
Rachel Sinha, Dimitris Papamargaritis, Jack Sargeant, Melanie Davies.
Published in Journal of Obesity & Metabolic Syndrome in March 2023
Abstract
The combination of glucagon-like peptide-1 (GLP-1) with other gut hormones including the glucose-dependent insulinotropic polypeptide (GIP) has been explored to complement and enhance further the GLP-1 effects on glycaemia and weight loss. Tirzepatide is the first dual GLP-1/GIP receptor co-agonist which has been approved for treatment of type 2 diabetes mellitus (T2DM) based on the findings from the SURPASS programme. The SURPASS trials assessed the safety and efficacy of tirzepatide in people with T2DM, from monotherapy through to insulin add-on in global populations, with another two trials dedicated to Japanese population. Over periods of treatment up to 104 weeks, once weekly tirzepatide 5 to 15 mg reduced glycosylated haemoglobin (1.87% to 3.02%), body weight (5.4 to 12.9 kg) and improved multiple cardiometabolic risk factors (including reduction in liver fat, new-onset macroalbuminuria, blood pressure, and lipids) across the T2DM spectrum. Tirzepatide provided better efficacy than placebo and other commonly used glucose-lowering medications such as semaglutide 1 mg, dulaglutide, insulin degludec, and glargine. All tirzepatide doses were well tolerated with similar side-effect profile to the GLP-1 receptor analogues. In people without diabetes, tirzepatide 5 to 15 mg once weekly for the treatment for obesity (SURMOUNT-1) resulted in substantial reductions in body weight (16.5% to 22.4%) over 72 weeks. Overall, the SURPASS program and SURMOUNT-1 study suggest that tirzepatide is marking a new era in T2DM and/or obesity management through dual agonism of gut hormones.
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