METABOLIC CHARACTERISTICS OF NEWLY DIAGNOSED ADULTS WITH EARLY & USUAL ONSET TYPE 2 DIABETES: A COMPARATIVE STUDY
	
Background
Early and usual onset type 2 diabetes (T2DM) may have a different etiopathological basis which, in turn, has considerable clinical and preventive implications. Also it is important to characterize these patients in various population groups due to the well known heterogeneity of T2DM.

Aim
In the present study, an attempt has been made to compare the anthropometric, clinical and biochemical characteristics of these two groups (<40 vs >40 years) in a Bangladeshi population.

Method
It was an observational analytical study with group comparison design involving early onset [n=97, age (years) 33.1±5.1, BMI (kg/m2) 24.9±4.5 M±SD] and usual onset[n=190, age (years) 52.0±8.1, BMI (kg/m2) 26.1±4.2 M±SD] type 2 diabetes following the NIHCE guideline for T2DM and Joint British Societies guideline. Subjects were selected randomly from the OPD of a tertiary care hospital in Bangladesh. Patients with severe physical and mental illness were excluded from the study. The clinical data were abstracted from patient’s medical guidebook and their characteristics were considered as age, weight, BMI, blood pressure and cholesterol within 3 months of diagnosis by using a semi-structured questionnaire by face to face interview. Univariate, bivariate and binary logistic regressions were performed to identify the factors independently associated with the groups (early vs. usual type 2 diabetes).

Results
Of the subjects, female preponderance was observed among early onset compared to usual onset group (70% vs 63%, p= 0.03). Adults with usual type 2 diabetes were more overweight (BMI 26.1 vs. 24.9 kg/m2, p= 0.04), had higher waist circumference (92.7 vs. 88.3 cm, p= 0.003), had a higher prevalence of hypertension (75% vs. 25% p<0.001), and had an equally high rate of Total cholesterol (197.1±43.7 vs. 193.1±56.4, p= 0.89) compared to their counterpart. There was a linear relationship between BMI and age at diagnosis of type 2 diabetes (p<0.05) in both groups. Multivariate analysis showed that in early onset group female gender, BMI and systolic blood pressure and in usual onset group BMI, waist circumference, and systolic blood pressure remain an independent association.

Discussion
The percentage of hypertension among early onset and usual onset type 2 DM group were 25% and 75%, respectively. This finding is very alarming for Bangladeshi population. Because the risk for Coronary Heart Disease in diabetics is doubles when hypertension is co-exists.

Obesity is directly related with onset of Type 2 diabetes mellitus and cerebro-vascular accident. This study found a linear positive relation with BMI and age of first diagnosis of type 2 DM. It reflects that in Bangladeshi population type 2 diabetes can be developed in over weight population and not necessarily among obese. The early onset Type 2 DM is not directly related with obesity in Bangladeshi population. The mean BMI and central obesity were somewhat more among usually onset of Type 2 DM patients.  Several studies on migrant Indians across the globe have shown that Asian Indians have an increased risk for developing type 2 diabetes and related metabolic abnormalities compared to other ethnic groups may be due to “Asian Indian phenotype” is considered to be one of the major factors contributing to the increased predilection towards diabetes In recent study, the mean±SD of other metabolic markers (FBS, DBP, TG, Total cholesterol, HDL, LDL, BMI, waist circumference) were not significantly different among two groups. This may be due to dissimilar ethnic and lifestyle pattern.

Although both onset groups were on average overweight, the inverse linear relationship suggests that overweight is a continuous risk rather than a threshold risk for diabetes onset. A high prevalence of cardiovascular disease risk factors is observed among both onset groups for this population. This study shows the importance of early initiation of metabolic markers screening among young population of Bangladesh to improve the quality of life and minimize the complications and expenditure cost for diseases management.

Conflict of Interest
I have no potential conflict of interest

Metabolic characteristics of newly diagnosed adults with early and usual onset type 2 diabetes: a comparative study