Comparison of beta-cell function between Hong Kong Chinese with young-onset type 2 diabetes and late-onset type 2 diabetes

Aims We compared beta-cell function in Chinese with type 2 diabetes diagnosed at age < 40 years (young-onset diabetes, YOD) and ≥ 40 years (late-onset diabetes, LOD). Methods In this cross-sectional study, we selected participants from two cohorts of people with type 2 diabetes recruited in 1996–2012 (n = 4,376) and 2020–2021 (n = 794). Multivariable linear regression models were applied to compare homeostasis model assessment of beta-cell function (HOMA2-%B) and fasting plasma C-peptide across diabetes duration at enrolment between YOD and LOD. Results The YOD group (n = 1,876, mean [SD] age: 39.9 [7.5] years, median [IQR] diabetes duration: 6 [ 2 Magliano D.J. Sacre J.W. Harding J.L. Gregg E.W. Zimmet P.Z. Shaw J.E. Young-onset type 2 diabetes mellitus - implications for morbidity and mortality. Nat Rev Endocrinol. 2020; 16: 321-331https://doi.org/10.1038/s41574-020-0334-z Crossref PubMed Scopus (173) Google Scholar , 3 Luk A.O.Y. Ke C. Lau E.S.H. et al. Secular trends in incidence of type 1 and type 2 diabetes in Hong Kong: A retrospective cohort study. PLoS Med. 2020; 17: e1003052 Crossref PubMed Scopus (44) Google Scholar , 4 Misra S. Ke C. Srinivasan S. et al. Current insights and emerging trends in early-onset type 2 diabetes. Lancet Diabetes Endocrinol. 2023; 11: 768-782https://doi.org/10.1016/S2213-8587(23)00225-5 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 5 Rise Consortium Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: I. Observations Using the Hyperglycemic Clamp. Diabetes Care. 2018; 41: 1696-1706https://doi.org/10.2337/dc18-0244 Crossref PubMed Scopus (110) Google Scholar , 6 Rise Consortium Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: II. Observations Using the Oral Glucose Tolerance Test. Diabetes Care. 2018; 41: 1707-1716https://doi.org/10.2337/dc18-0243 Crossref PubMed Scopus (66) Google Scholar , 7 Rise Consortium Effects of Treatment of Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes With Metformin Alone or in Combination With Insulin Glargine on beta-Cell Function: Comparison of Responses In Youth And Adults. Diabetes. 2019; 68: 1670-1680https://doi.org/10.2337/db19-0299 Crossref PubMed Scopus (76) Google Scholar , 8 Utzschneider KM, Tripputi MT, Kozedub A, et al. Differential loss of β-cell function in youth vs. adults following treatment withdrawal in the Restoring Insulin Secretion (RISE) study. Diabetes research and clinical practice. 2021;178:108948. https://doi.org/10.1016/j.diabres.2021.108948. Google Scholar , 9 Sam S. Edelstein S.L. Arslanian S.A. et al. Baseline Predictors of Glycemic Worsening in Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study. Diabetes Care. 2021; 44: 1938-1947https://doi.org/10.2337/dc21-0027 Crossref PubMed Scopus (18) Google Scholar , 10 Ma R.C. Chan J.C. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013; 1281: 64-91https://doi.org/10.1111/nyas.12098 Crossref PubMed Scopus (557) Google Scholar , 11 Li X. Yang S. Cao C. et al. Validation of the Swedish Diabetes Re-Grouping Scheme in Adult-Onset Diabetes in China. J Clin Endocrinol Metab. 2020;105:dgaa524.; https://doi.org/10.1210/clinem/dgaa524 Crossref Scopus (26) Google Scholar , 12 Anjana R.M. Baskar V. Nair A.T.N. et al. Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study. BMJ Open Diabetes Res Care. 2020; 8: e001506 Crossref PubMed Scopus (83) Google Scholar ] years) was more likely to have family history of diabetes (61.6 % vs 43.6 %), obesity (41.9 % vs 26.8 %), dyslipidaemia (61.7 % vs 54.4 %), and worse glycaemic control (mean HbA1c 7.7 % vs 7.4 %) than those with LOD (n = 3,294, age: 60.8 [10.6] years, diabetes duration: 5 [ 1 Lascar N. Brown J. Pattison H. Barnett A.H. Bailey C.J. Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diab Endocrinol. 2018; 6: 69-80https://doi.org/10.1016/S2213-8587(17)30186-9 Abstract Full Text Full Text PDF PubMed Scopus (422) Google Scholar , 2 Magliano D.J. Sacre J.W. Harding J.L. Gregg E.W. Zimmet P.Z. Shaw J.E. Young-onset type 2 diabetes mellitus - implications for morbidity and mortality. Nat Rev Endocrinol. 2020; 16: 321-331https://doi.org/10.1038/s41574-020-0334-z Crossref PubMed Scopus (173) Google Scholar , 3 Luk A.O.Y. Ke C. Lau E.S.H. et al. Secular trends in incidence of type 1 and type 2 diabetes in Hong Kong: A retrospective cohort study. PLoS Med. 2020; 17: e1003052 Crossref PubMed Scopus (44) Google Scholar , 4 Misra S. Ke C. Srinivasan S. et al. Current insights and emerging trends in early-onset type 2 diabetes. Lancet Diabetes Endocrinol. 2023; 11: 768-782https://doi.org/10.1016/S2213-8587(23)00225-5 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 5 Rise Consortium Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: I. Observations Using the Hyperglycemic Clamp. Diabetes Care. 2018; 41: 1696-1706https://doi.org/10.2337/dc18-0244 Crossref PubMed Scopus (110) Google Scholar , 6 Rise Consortium Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: II. Observations Using the Oral Glucose Tolerance Test. Diabetes Care. 2018; 41: 1707-1716https://doi.org/10.2337/dc18-0243 Crossref PubMed Scopus (66) Google Scholar , 7 Rise Consortium Effects of Treatment of Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes With Metformin Alone or in Combination With Insulin Glargine on beta-Cell Function: Comparison of Responses In Youth And Adults. Diabetes. 2019; 68: 1670-1680https://doi.org/10.2337/db19-0299 Crossref PubMed Scopus (76) Google Scholar , 8 Utzschneider KM, Tripputi MT, Kozedub A, et al. Differential loss of β-cell function in youth vs. adults following treatment withdrawal in the Restoring Insulin Secretion (RISE) study. Diabetes research and clinical practice. 2021;178:108948. https://doi.org/10.1016/j.diabres.2021.108948. Google Scholar , 9 Sam S. Edelstein S.L. Arslanian S.A. et al. Baseline Predictors of Glycemic Worsening in Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study. Diabetes Care. 2021; 44: 1938-1947https://doi.org/10.2337/dc21-0027 Crossref PubMed Scopus (18) Google Scholar , 10 Ma R.C. Chan J.C. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013; 1281: 64-91https://doi.org/10.1111/nyas.12098 Crossref PubMed Scopus (557) Google Scholar ] years). When compared to people with LOD, HOMA2-%B and fasting plasma C-peptide were lower in the YOD group, consistently among those with BMI < 27.5 kg/m2 and HOMA2-IR ≤ 1.6 (median value), adjusted for year at enrolment, sex, diabetes duration, family history of diabetes, HbA1c, weight and lipid indices (p < 0.01). Cross-sectionally, the slopes of decline in HOMA2-%B by diabetes duration were greater in YOD than LOD among individuals with BMI < 27.5 kg/m2 (p-interaction = 0.015). Conclusions Chinese with YOD had accelerated loss of beta-cell function than those with LOD especially in non-obese individuals.