Diabetes Diabetes Basics

Generation D: Young Adults with Diabetes

Because we're now seeing diabetes in younger people, they've tried to distinguish between type 1 versus type 2. Type 1 occurs when you lose your ability to make any insulin. Everyone with that illness requires insulin from the start. In type 2, which is what 95 percent of the people with diabetes have, there's a relative insulin deficiency; you make insulin, but it's not enough or it doesn't work well enough to have you store the sugar from your meals into your fat and muscle cells.

How was diabetes different in young adults?
It was more aggressive from a heart standpoint. There are several types of complications that occur with diabetes. There is what's called the microvascular complications, which affect the small blood vessels, and can cause blindness or kidney failure or loss of sensation that can lead to amputation in some people with diabetes.

The macrovascular disease affects the large blood vessels, and can cause heart disease and stroke. More than half the people with type 2 diabetes die from the consequences of macrovascular disease. And while the microvascular complications are important, what we're trying to prevent in type 2 diabetes is cardiovascular disease.

So it's the macrovascular disease where we saw the main differences between younger and older adults. Although the absolute rates of heart disease in older people with or without diabetes are still higher, what we really wanted to know was how diabetes is affecting this risk.

We did that by comparing people with new-onset diabetes and looking at their risk of developing a heart attack or a stroke or of needing procedures for a heart attack such as coronary bypass surgery. We compared this group to people without diabetes who were the same age and gender.

What we found was that young adults 18 to 44 with diabetes had a 14-fold higher rate of heart disease compared to their peers, whereas in older adults, that ratio was 4-fold higher. And so that's what we're saying about it being more aggressive.

Similarly, for strokes, we found that up to 30 times higher in young adults versus their peers and, in older adults with diabetes, strokes were 3-fold higher than among their peers.

So people at a younger age aren't getting heart attacks or strokes unless they have diabetes.

Did the two age groups require different treatment strategies?
Although younger and older adults, on average, required treatment after the same amount of time, there were a lot more people in the younger group who needed insulin. People with the early onset were 80 percent more likely to begin insulin therapy.

The reason that you need insulin that is eventually the pancreas kind of burns out and it's not able to keep up with making insulin, so the pancreas is losing it's ability to do that more quickly in younger adults. So that's another reason why it's more aggressive.

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