Incident cardiovascular-kidney disease, diabetic ketoacidosis, hypoglycaemia and mortality in adult-onset type 1 diabetes: a population-based retrospective cohort study in Hong Kong

Yingnan Fan; Eric S H Lau; Hongjiang Wu; Aimin Yang; Elaine Chow; Alice P S Kong; Ronald C W Ma; Juliana C N Chan; Andrea O Y Luk

doi:10.1016/j.lanwpc.2023.100730

Incident cardiovascular-kidney disease, diabetic ketoacidosis, hypoglycaemia and mortality in adult-onset type 1 diabetes: a population-based retrospective cohort study in Hong Kong

Lancet Reg Health West Pac. 2023 Mar 16:34:100730. doi: 10.1016/j.lanwpc.2023.100730. eCollection 2023 May.

Authors

Yingnan Fan¹, Eric S H Lau¹, Hongjiang Wu¹, Aimin Yang¹, Elaine Chow¹, Alice P S Kong^{1

2

3}, Ronald C W Ma^{1

2

3}, Juliana C N Chan^{1

2

3}, Andrea O Y Luk^{1

2

3}

Affiliations

¹ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, PR China.
² Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, PR China.
³ Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, PR China.

Abstract

Background: Type 1 diabetes can occur at any age. The majority of literature on type 1 diabetes were reported in children whereas adult-onset type 1 diabetes is less well characterised. This study aims to compare the risk of diabetes-related complications and mortality in Chinese with adult-onset type 1 diabetes versus those with youth-onset type 1 diabetes and adult-onset type 2 diabetes.

Methods: Between 2000 and 2018, 2738 people with type 1 and 499,288 with type 2 diabetes underwent metabolic and complication assessment in Hong Kong Hospital Authority. They were followed for incident diabetic ketoacidosis (DKA), severe hypoglycaemia, end-stage kidney disease (ESKD), cardiovascular disease (CVD) and all-cause mortality until 2019.

Findings: In multivariable Cox regression adjusted for sex, diabetes duration and calendar year, people with type 1 diabetes diagnosed aged ≥40 years had a lower hazard of DKA (hazard ratio HR [95% CI] 0.47 [0.32-0.70]) but higher hazards of severe hypoglycaemia (HR 1.37 [1.13-1.67]), ESKD (HR 4.62 [2.90-7.37]), CVD (HR 11.44 [6.92-18.91]) and mortality (HR 16.22 [11.43-23.02]) versus those diagnosed aged <20 years. Compared with peers with type 2 diabetes presenting at comparable age, people with type 1 diabetes diagnosed aged ≥40 years had higher age-, sex- and diabetes duration-adjusted hazards of DKA (HR 19.87 [13.95-28.31]), severe hypoglycaemia (HR 3.26 [2.81-3.80]), ESKD (HR 1.58 [1.20-2.09]) and mortality (HR 2.26 [1.96-2.60]), and a similar hazard of CVD (HR 1.11 [0.87-1.43]). These associations remained constant after adjustment for metabolic indices.

Interpretation: People with type 1 diabetes diagnosed in late adulthood had elevated risks of a broad range of complications and mortality compared with people with youth-onset type 1 diabetes and people with type 2 diabetes presenting at same age bands.

Funding: This study did not receive any specific funding.

Keywords: Adult-onset diabetes; Cardiovascular disease; Diabetic ketoacidosis; End-stage kidney diseases; Hypoglycaemia; Mortality; Type 1 diabetes.