An Early-Onset Subgroup of Type 2 Diabetes: A Multigenerational, Prospective Analysis in the Framingham Heart Study

Abstract

OBJECTIVE To assess the relation of type 2 diabetes occurring earlier (age <55 years) versus later in life to the risk of cardiovascular death and to diabetes in offspring.

RESEARCH DESIGN AND METHODS In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5,571 first- and second-generation participants with mortality data and 2,123 second-generation participants who initially did not have diabetes with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death)–control (noncardiovascular death) design and incident diabetes in offspring in relation to parental early-onset diabetes.

RESULTS Among the participants in two generations (N = 5,571), there were 1,822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus noncardiovascular death increased with decreasing age of diabetes onset (P < 0.001 trend). Compared with never developing diabetes, early-onset diabetes conferred a 1.81-fold odds (95% CI 1.10–2.97, P = 0.02) of cardiovascular death and 1.75-fold odds (0.96–3.21, P = 0.07) of coronary death, whereas later-onset diabetes was not associated with greater risk for either (P = 0.09 for cardiovascular death; P = 0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73–6.07), whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50–3.19).

CONCLUSIONS Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.

Diabetes Care 2020 Dec; 43(12): 3086-3093. https://doi.org/10.2337/dc19-1758

Translation – The earlier you develop diabetes your risk of CVD and coronary death is higher. An if one or both of your parents developed either early onset or late onset diabetes you’re screwed.

4 thoughts on “An Early-Onset Subgroup of Type 2 Diabetes: A Multigenerational, Prospective Analysis in the Framingham Heart Study

    • My Dad developed DM2 at age 50. Youngest brother diagnosed in his mid-20’s. I asked one of the top Endocrinologists in Dallas for advice and I quote “Stay as thin as you can as long as you can.” My fasting glucose levels are still normal and the last A1C years ago was 5.8.

      • I think that was good advice. Being thin and calorie restriction also increase longevity. Up to a point.

        Your brother had type two diabetes in his mid-20s? That was extremely usually unusual back in the day. I hear of it now in children. But didn’t see it frequently back in the 60s and 70s.

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