• Although type 2 diabetes (T2D) is more common in later life, there has been a huge increase in early-onset cases, usually associated with obesity.
• A new study has found that the life expectancy of people diagnosed with diabetes by the age of 30 is 14 years less than for those without diabetes.
• However, another study has found that the injectable treatment tirzepatide (Mounjaro) is as effective in those with early-onset diabetes as it is in those who develop the condition later in life.

Type 2 diabetes is a chronic condition that develops when the body either stops making enough insulin — the hormone that controls blood glucose — or stops responding to it.

Insulin moves glucose — produced from the digestion of food — from the blood to cells where it can be used. Insulin resistance, when the cells stop responding to insulin, can lead to prediabetes and type 2 diabetes.

In the past, type 2 diabetes was thought to develop only in older people, and it is still more common in those ages 50 years and older. However, cases in younger people are increasing. Risk factors include obesity, a sedentary lifestyle, close relatives with type 2 diabetes, being of black and minority ethnic origin, and being from a less affluent socioeconomic group.

A new study, published in the Lancet Diabetes & Endocrinology, has looked at the effect of a type 2 diabetes diagnosis on life expectancy.

The findings highlight that being diagnosed with type 2 diabetes shortened life expectancy by an average of six years. However, if that diagnosis was at the age of 30, life expectancy was reduced by 14 years.

However, in more promising news, another study found that tirzepatide, a new injectable diabetes drug, is as effective in those with early-onset type 2 diabetes as it is in people who develop the condition later in life.

This research was presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany.

Diabetes reduces life expectancy

In a study using data from two large-scale sources — the Emerging Risk Factors Collaboration and the UK Biobank — researchers investigated associations between age at diabetes diagnosis and life expectancy.

They found that for every decade earlier that type 2 diabetes was diagnosed, life expectancy was reduced by 3-4 years.

“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, speaking to 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.

One of the authors, Prof. Naveed Sattar from the Institute of Cardiovascular & Medical Sciences, University of Glasgow, said in a press release: “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 a hopeful note: “But 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.”

Effective drug to treat early-onset diabetes

In another study, there is potential good news for those with early-onset type 2 diabetes.

Researchers found that tirzepatide (Mounjaro), one of a 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 United States in May 2022 and in the United Kingdom for “difficult to manage type 2 diabetes” in September 2023.

In this study, researchers from the University of Leicester, U.K., and the U.S., 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 program (SURPASS-1, -2, -3 and -5) for three different doses of tirzepatide — 5mg, 10mg, and 15mg.

They found that tirzepatide was equally effective in both groups at all three doses. Both groups showed improved average blood glucose levels and body weight after 40 or 52 weeks. Their waist circumference, lipids, and systolic blood pressure also improved.

Why early-onset type 2 diabetes is dangerous

Type 2 diabetes that is diagnosed in childhood or early adulthood (below the age of 40) is classified as early-onset type 2 diabetes.

Early-onset diabetes 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.”
— Prof. Melanie Davies, corresponding author, University of Leicester, Leicester, U.K.

How to reduce type 2 diabetes risk

The Centers for Disease Control and Prevention advises several ways to reduce the risk of type 2 diabetes:

• Lose weight and keep it off: People may be able to prevent or delay diabetes by losing 5 to 7% percent of their starting weight.
• Eat a healthier diet: Replace processed foods, trans fats, sugary drinks, and alcohol with non-starchy vegetables, lean protein, whole grains, water, and unsweetened beverages.
• Move more: Aim for at least 30 minutes of physical activity five days a week. If you have not been active, talk with your healthcare professional and slowly build up to your goal.
• Make a plan and track your progress to try and make the lifestyle changes permanent.

“People can ensure they are eating healthy, whole foods. Eat a balanced diet, low in refined carbohydrates, refined sugars, saturated fats, and processed foods. Exercise on a regular basis. Maintain a healthy, non-overweight, non-obese body weight.”
— Dr. Ishita Prakash Patel, board-certified endocrinologist, Texas Diabetes and Endocrinology in Austin, Texas, who was not involved in the study, speaking to MNT

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