A study has found that young adults with diabetes have a worse cardiometabolic risk profile than young adults without diabetes.

Young adults with diabetes have high rates of cardiometabolic risk factors, such as adiposity, blood pressure, chronic kidney disease, uncontrolled high cholesterol, and history of cardiovascular disease. These are all risk factors that can lead to an increased disease prevalence and mortality rate among these young adults as they age.

While the United States has seen lower mortality rates among adults with diabetes during recent decades, the overall burden of the condition among young adults is expected to climb to over 5 million by 2030. That age group has also not seen improvements in lower mortality rates.

Researchers defined diabetes by self-reported diagnosis, by a health care provider, or by glycated hemoglobin levels 6.5% or higher, and excluded diagnosis only during pregnancy. Demographics included age, sex, race or ethnicity, income, and health insurance status. The participants were stratified into 2 age categories: 18-44 years old and 45 or older.

Cardiometabolic risk factors included measures of adiposity (defined using BMI), serum cholesterol, blood pressure, blood glucose control, chronic kidney disease, history of cardiovascular disease, health eating, leisure-time physical activity, and exposure to tobacco smoke.

The researchers used demographic data and cardiometabolic risk profiles to compare risk profiles of younger versus older with diabetes. Adults with diabetes in both age groups were found to have higher levels of adiposity, hypertension, cholesterol, and lower levels of healthy eating and leisure time physical activity.

The researchers found several differing demographics and health care access characteristics when comparing young adults with diabetes to those without diabetes. Those with diabetes were older (mean age of 36.4 years compared with 30.9 years), fewer were non-Hispanic white, and more were non-Hispanic black. Young adults with diabetes were more likely to have only public health insurance compared with young adults without diabetes.

Furthermore, the percentage of young adults with diabetes who were obese was twice as high compared with young adults without diabetes. They were also less likely to engage in leisure-time physical activity than their counterparts without diabetes.

Differences in high cholesterol and adiposity by those with and without diabetes were greater among young adults versus older adults after adjusting for demographics and insurance status.

Elevated lipids were 9.6 percentage points higher and obesity was 37.3 percentage points higher among young adults with diabetes compared to those without diabetes than among older adults with diabetes compared to those without diabetes.

Young adults with diabetes were less likely than older adults with diabetes to report taking medication for high cholesterol and hypertension. Among those with diabetes, 25.5% of young adults and 12.6% of older adults had A1C levels above 9%.

Overall, the researchers found that young adults with diabetes are nearly twice as likely to have obesity, elevated lipids, or hypertension, and are less likely to report a healthy diet or physical activity. The authors noted that promoting healthy diets and increased physical activity among young adults may reduce their cardiometabolic risk.

Finally, the authors noted that the possible reasons and causes for the differences they found by diabetes status and age are likely complex, especially in regard to health care access and utilization. Increasing access to health care may also make a substantial difference in cardiometabolic risks among young adults, considering that they are almost twice as likely to have no health insurance compared with older adults.


REFERENCE

Saydah S, Siegel K, Imperatore G, Mercado C, et al. (2019). The Cardiometabolic Risk Profile of Young Adults With Diabetes in the US. Diabetes Care, 42(10), pp.1895-1902.