To investigate the relationship between age at diagnosis of type 2 diabetes mellitus (T2DM) and diabetes distress (DD) in adults with T2DM.

This study was a prospective cohort study. A total of 3 354 T2DM patients were enrolled at Taiwan Li′s United Clinic from January 1, 2002. According to the age of T2DM diagnosis, the patients were divided into<40 years old group (young group, 488 cases), 40-59 years old group (middle-aged group, 2 055 cases), and≥60 years old group (elderly group, 811 cases). General data (age, sex, smoking history, drinking history, family history, diabetes course, economic income, educational level, marital status, and physical activity) and clinical indicators [body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), glycated hemoglobin A_1c (HbA_1c), etc.] of the patients were collected. And the characteristics of the disease (whether there are sleep disorders, DD, complications) and medication (antihypertensive drugs, lipid-regulating drugs, hypoglycemic drugs, insulin). The problem areas in diabetes (PAID) scale was used to determine whether T2DM patients had DD. One-way analysis of variance (ANOVA), Kruskal-Wallis H rank sum test and χ² test were used to compare between groups. Cox regression analysis was used to analyze the influencing factors of DD and the relationship between age at diagnosis and DD.

There were no significant differences in family history of diabetes, sleep status and proportion of lipid-regulating drugs used among the three groups (P>0.05). Compared with the middle-aged group and the elderly group, T2DM patients in the young group had a longer duration of diabetes, a higher proportion of insulin use, smoking history and drinking history, and a higher level of BMI, HbA_1c and Hb with statistical significance (P<0.05). Multivariate Cox regression analysis was conducted with age at diagnosis, sex, disease course, BMI, economic status, exercise habits, HbA_1c, hemoglobin, marital status, education level and drug use as independent variables and whether DD occurred as dependent variables. The results showed that, younger age at diagnosis, female, and BMI were independent risk factors for the development of DD (HR=0.962, 1.820, 1.037, all P<0.05). After follow-up, the number of DD cases in the young, the middle-aged and elderly groups was 41, 96 and 23 cases, respectively. Cox regression analysis showed that after adjusting for disease course, sex, income, education, marital status, BMI, HbA_1c, drug use, hemoglobin, sleep and complications, the risk of DD in the young group was 3.260 times that of the elderly group (95%CI 1.728-6.151, P<0.05).

Patients diagnosed with T2DM at an earlier age have a higher risk of DD, indicating the need for age-appropriate psychosocial support.

Diabetes mellitus, type 2; Diabetes-related issues; Age at diagnosis; Regression analysis