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The risk of mortality is higher in those diagnosed with type 2 diabetes at a younger age
Last reviewed: 02.07.2025
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A recent randomized controlled trial found that type 2 diabetes occurring at a young age significantly increases the risk of mortality compared with later diagnoses.
In a study published in The Lancet Diabetes & Endocrinology, researchers assessed whether mortality and complication rates differ between early- and late-onset type 2 diabetes (T2D). Although T2D is traditionally viewed as a disease of middle-aged and older adults, its onset at younger ages is recognized as a distinct non-autoimmune phenotype. There are concerns that early exposure to hyperglycemia in people with early-onset T2D may increase the risk of complications and shorten life expectancy.
In this study, the researchers used data from the UK Prospective Diabetes Study (UKPDS) collected between 1977 and 2007. The study participants included 4,550 patients with T2D who did not have diabetes-related autoantibodies. A diagnosis of T2D before age 40 was defined as early onset, while a diagnosis at age 40 or older was considered late onset.
Participants were randomly assigned to receive either conventional glycemic control (primarily diet) or an intensive strategy (insulin, metformin, or sulfonylurea). The researchers assessed seven aggregated outcomes, including diabetes endpoints, diabetes mortality, all-cause death, myocardial infarction, peripheral vascular disease, stroke, and microvascular events.
The study found that 429 participants had early-onset T2D with a mean age of 35.1 years, while the remaining participants had late-onset with a mean age of 53.8 years. Participants with early-onset T2D had a higher body mass index (BMI) and higher triglyceride levels.
The percentage of participants who developed diabetic complications was 47.1% in the early-onset T2D group and 73.2% in the late-onset group. During follow-up, there were 2,048 deaths over 74,979 patient-years.
Although the early-onset T2D group had a lower mortality rate, it also showed a higher rate of excess diabetes-related mortality compared with the late-onset group. The highest standardized mortality ratio (SMR) was observed in the youngest group (24-35 years), with the SMR decreasing with increasing age at T2D diagnosis.
Overall, the study results show that early onset T2D is associated with a greater risk of diabetic complications, poor glycemic control and excess mortality compared with people with late onset T2D. These results highlight the need to develop services and interventions aimed at identifying and managing these patients.