The population-based cohort study revealed that adults with congenital heart disease (CHD) are not only more likely to develop type 2 diabetes but also tend to develop it at a younger age than the general population. The findings, presented by Dr. Sabrina Maya D’Angelo, an internal medicine resident at McGill University, emphasize the need for proactive diabetes screening and management in this vulnerable group.
“Diabetes is a growing epidemic,” according to Dr. D’Angelo. “Earlier studies, such as those by Dr. Jonathan Afilalo and colleagues in 2011, identified diabetes as a major comorbidity influencing mortality in older adults with congenital heart disease. Our goal was to shift the focus to younger patients and explore how early diabetes affects outcomes.”
The study had three primary objectives: to determine the incidence of type 2 diabetes among adults with congenital heart disease compared with the general population, to identify predictors of early-onset diabetes, and to examine how early-onset diabetes affects mortality risk.
Using the Quebec Congenital Heart Disease Database, researchers analyzed data spanning from 1983 to 2017. The dataset included information on hospitalizations, outpatient care, socioeconomic status, and mortality. Out of 137,656 individuals with CHD, 84,253 adults met the inclusion criteria for the study.
Early-onset type 2 diabetes was defined as a diagnosis by age 40 or younger. To account for confounding factors, the team used propensity score matching and adjusted for the competing risk of death when evaluating survival outcomes.
Key Findings:
- Among patients who developed type 2 diabetes, 30,196 cases occurred by age 40.
- The propensity-score matched analysis included 8,825 patient pairs: 2,802 with early-onset diabetes and 14,848 with late-onset diabetes.
- Adults with congenital heart disease had a higher incidence of type 2 diabetes compared with the general Canadian population, especially in younger and older age groups.
- In the 20–34 years age group, the incidence was 1.88 vs 1.40 per 1,000 person-years.
- In the 65–79 years age group, the incidence was 23.37 vs 15.14 per 1,000 person-years.
- Patients with more severe congenital heart disease had higher diabetes incidence than those with milder forms (2.47 vs 1.80 per 1,000 person-years).
- Early-onset diabetes was associated with a higher mortality risk, with a hazard ratio of 4.19 compared to 1.65 for late-onset diabetes.
- Predictors of early-onset diabetes included obesity, hypertension, dyslipidemia, and chronic kidney or liver disease.
- Male sex appeared protective with a hazard ratio of 0.69, indicating that women with congenital heart disease may be at greater risk.
"These findings underline the importance of early metabolic screening and aggressive risk factor management in adults living with congenital heart disease. Early detection and intervention, researchers suggest, could help mitigate the compounding impact of diabetes on long-term survival in this high-risk population," the authors concluded.
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