Calvin Ke, MD; Eric Lau, PhD; Baiju R. Shah, MD, PhD; Thérèse A. Stukel, PhD; Ronald C. Ma, MB BChir; Wing-Yee So, MBChB, MD; Alice P. Kong, MD; Elaine Chow, MBChB, PhD; Philip Clarke, PhD; William Goggins, ScD; Juliana C.N. Chan, MBChB, MD; Andrea Luk, MBChB, MD
Presented in part at the American Diabetes Association's 78th Scientific Sessions, Orlando, Florida, 22–26 June 2018.
Note: The HKDR was established as a research-driven quality improvement program initiated by the Chinese University of Hong Kong (CUHK)-Prince of Wales Hospital Diabetes Care and Research Team, supported by the Hong Kong Foundation for Research and Development in Diabetes established at CUHK. In 2007, this was merged with the Web-based JADE Technology, complete with care protocols, risk stratification, personalized reporting, and decision support. The JADE Technology was designed and implemented by the Asia Diabetes Foundation to enable other clinics and hospitals to establish diabetes registers and contribute anonymized data for research purposes. The Asia Diabetes Foundation was set up as a charitable research organization governed by the CUHK Foundation.
Acknowledgment: The authors thank the Hong Kong Hospital Authority for providing data for this study.
Financial Support: By the Asia Diabetes Foundation. Dr. Ke is supported by the Canadian Institutes of Health Research Canada Graduate Scholarship and Michael Smith Foreign Study Supplements, the University of Toronto Clinician Investigator Program, the Canadian Society of Endocrinology and Metabolism Dr. Fernand Labrie Fellowship Research Grant, and the Royal College of Physicians and Surgeons of Canada Detweiler Travelling Fellowship.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1900.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Prof. Chan (e-mail, firstname.lastname@example.org). Data set: Not publicly available. Interested researchers may apply for access through Shirley Au, for the Secretary of the Central Panel on Administrative Assessment of External Data Requests, Hospital Authority, Hong Kong Special Administrative Region (e-mail, email@example.com).
Corresponding Author: Juliana C.N. Chan, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Lui Che Woo Clinical Sciences Building, 9th Floor, Room 114025, Shatin, New Territories, Hong Kong; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Ke, Shah, and Stukel: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Suite G106, Toronto, Ontario M4N 3M5, Canada.
Dr. Lau: Asia Diabetes Foundation, Unit 3, 17th Floor, Metropole Square, 2 On Yiu Street, Shatin, New Territories, Hong Kong.
Drs. Ma, So, Kong, Chan, Chow, and Luk: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Lui Che Woo Clinical Sciences Building, 9th Floor, Shatin, New Territories, Hong Kong.
Dr. Clarke: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Dr. Goggins: The Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Author Contributions: Conception and design: C. Ke, T.A. Stukel, W.Y. So, J.C.N. Chan, A. Luk.
Analysis and interpretation of the data: C. Ke, E. Lau, B.R. Shah, P. Clarke, W. Goggins, J.C.N. Chan.
Drafting of the article: C. Ke.
Critical revision of the article for important intellectual content: C. Ke, B.R. Shah, T.A. Stukel, R.C. Ma, W.Y. So, E. Chow, W. Goggins, J.C.N. Chan, A. Luk.
Final approval of the article: C. Ke, E. Lau, B.R. Shah, T.A. Stukel, R.C. Ma, W.Y. So, A.P. Kong, E. Chow, P. Clarke, W. Goggins, J.C.N. Chan, A. Luk.
Provision of study materials or patients: R.C. Ma, A.P. Kong, J.C.N. Chan.
Statistical expertise: T.A. Stukel.
Obtaining of funding: J.C.N. Chan.
Administrative, technical, or logistic support: R.C. Ma, W.Y. So, J.C.N. Chan, A. Luk.
Collection and assembly of data: W.Y. So, A.P. Kong, J.C.N. Chan, A. Luk.
Type 2 diabetes (T2D) increases hospitalization risk. Young-onset T2D (YOD) (defined as onset before age 40 years) is associated with excess morbidity and mortality, but its effect on hospitalizations is unknown.
To determine hospitalization rates among persons with YOD and to examine the effect of age at onset on hospitalization risk.
Prospective cohort study.
Adults aged 20 to 75 years in population-based (2002 to 2014; n = 422 908) and registry-based (2000 to 2014; n = 20 886) T2D cohorts.
All-cause and cause-specific hospitalization rates. Negative binomial regression models estimated effect of age at onset on hospitalization rate and cumulative bed-days from onset to age 75 years for YOD.
Patients with YOD had the highest hospitalization rates by attained age. In the registry cohort, 36.8% of YOD bed-days before age 40 years were due to mental illness. The adjusted rate ratios showed increased hospitalization in YOD versus usual-onset T2D (onset at age ≥40 years) (all-cause, 1.8 [95% CI, 1.7 to 2.0]; renal, 6.7 [CI, 4.2 to 10.6]; diabetes, 3.7 [CI, 3.0 to 4.6]; cardiovascular, 2.1 [CI, 1.8 to 2.5]; infection, 1.7 [CI, 1.4 to 2.1]; P < 0.001 for all). Models estimated that intensified risk factor control in YOD (hemoglobin A1c level <6.2%, systolic blood pressure <120 mm Hg, low-density lipoprotein cholesterol level <2.0 mmol/L [<77.3 mg/dL], triglyceride level <1.3 mmol/L [<115.1 mg/dL], waist circumference of 85 cm [men] or 80 cm [women], and smoking cessation) was associated with a one-third reduction in cumulative bed-days from onset to age 75 years (97 to 65 bed-days).
Possible residual confounding.
Adults with YOD have excess hospitalizations across their lifespan compared with persons with usual-onset T2D, including an unexpectedly large burden of mental illness in young adulthood. Efforts to prevent YOD and intensify cardiometabolic risk factor control while focusing on mental health are urgently needed.
Asia Diabetes Foundation.
Ke C, Lau E, Shah BR, Stukel TA, Ma RC, So W, et al. Excess Burden of Mental Illness and Hospitalization in Young-Onset Type 2 Diabetes: A Population-Based Cohort Study. Ann Intern Med. [Epub ahead of print 15 January 2019]170:145–154. doi: 10.7326/M18-1900
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Published: Ann Intern Med. 2019;170(3):145-154.
Published at www.annals.org on 15 January 2019
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Hospital Medicine.
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