• Journal Article

Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus

Citation

Rhodes, E. T., Prosser, L. A., Hoerger, T., Lieu, T., Ludwig, D. S., & Laffel, L. M. (2012). Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus. Diabetic Medicine, 29(4), 453-463. DOI: 10.1111/j.1464-5491.2011.03542.x

Abstract

Aims: To estimate remaining life expectancy, quality-adjusted life expectancy, causes of death and lifetime cumulative incidence of microvascular/macrovascular complications of diabetes for youths diagnosed with Type 2 diabetes. Methods: A Markov-like computer model simulated the life course for a hypothetical cohort of adolescents/young adults in the USA, aged 15-24 years, newly diagnosed with Type 2 diabetes following either conventional or intensive treatment based on the UK Prospective Diabetes Study. Outcomes included remaining life expectancy, discounted quality-adjusted life expectancy in quality-adjusted life years, cumulative incidence of microvascular/macrovascular complications and causes of death. Results: Compared with a mean remaining life expectancy of 58.6 years for a 20-year-old in the USA without diabetes, conventional treatment produced an average remaining life expectancy of 43.09 years and 22.44 discounted quality-adjusted life years. Intensive treatment afforded an incremental 0.98 years and 0.44 discounted quality-adjusted life years. Intensive treatment led to lower lifetime cumulative incidence of all microvascular complications and lower mortality from microvascular complications (e.g. end-stage renal disease death 19.4% vs. 25.2%). Approximately 5% with both treatments had end-stage renal disease within 25 years. Lifetime cumulative incidence of coronary heart disease increased with longer remaining life expectancy and greater severity of coronary heart disease risk factors. Incorporating disutility (loss in health-related quality of life) of intensive treatment resulted in net loss of quality adjusted life years.. Conclusions: Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average remaining life expectancy and may experience severe, chronic complications of Type 2 diabetes by their 40s. The net clinical benefit of intensive treatment may be sensitive to preferences for treatment. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of coronary heart disease. (c) 2011 The Authors. Diabetic Medicine(c) 2011 Diabetes UK