Diabetes duration is linked to the risk of microvascular complications in smaller blood vessels such as those in the eyes, a large Australian-led study has found. For each five-year increase in duration of type 2 diabetes, the multiple adjusted risk of microvascular events such as new or worsening retinopathy was increased by 28 per cent.
Researchers said this meant that younger people with diabetes were more at risk of microvascular complications as they were more likely to have diabetes for longer over their lifetime than those diagnosed at an older age.
‘A refocus towards intensive management of hyperglycaemia at diagnosis, particularly in younger people, may be warranted if the long-term risk of microvascular complications is to be minimised,’ researchers wrote in Diabetologia.
‘With the increasing number of non-pharmacological and pharmacological approaches to improve glycaemic control, this objective should be achievable.’
Researchers investigated associations between age, age at diagnosis of diabetes, diabetes duration and vascular complications in a study of a large and diverse population of 11,140 people with type 2 diabetes. Diabetes duration was independently associated with the risk of microvascular complications, and the effects of diabetes duration were greatest at younger rather than older ages.
‘Intensive glycaemic control of young people diagnosed with type 2 diabetes is warranted early to minimise the risk of microvascular complications,’ they said.
‘Our data further suggest that both intensity of hyperglycaemia and a more susceptible microvasculature may explain the greater risk of microvascular complications in younger people than older people with type 2 diabetes.’
They said people who develop type 2 diabetes at a younger age may have a different phenotype from those who develop it later, so that worse glycaemic control and greater microvascular damage is experienced.
The research, led by Associate Professor Sophia Zoungas from The George Institute for Global Health, University of Sydney, also involved Victorian colleagues from the University of Melbourne, Monash University and Baker IDI Heart and Diabetes Institute and researchers from overseas.
Zoungas S et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia 2014; 57: 12: 2465-2474. doi: 10.1007/s00125-014-3369-7.