Glycaemic Trajectory before Diabetes Diagnosis in People with Young-Onset and Usual-Onset Type 2 Diabetes-A Population-Based Retrospective Study in Hong Kong

Objectives: To identify distinct glycaemic trajectories before diabetes diagnosis in people with young-onset (<40 years) and usual-onset type 2 diabetes (≥40 years). Methods: Adult patients with incident type 2 diabetes diagnosed between 2002 and 2019 who had at least three HbA1c measurements before diabetes diagnosis in Hong Kong Hospital Authority electronic medical record system were included in this study. Latent class trajectory modelling was applied to identify distinct HbA1c trajectories before diabetes diagnosis, adjusted for sex and age. The shape and number of trajectory classes (one to five) were selected based on a combination of Bayesian Inclusion Criteria, model adequacy and proportion of people in each trajectory class (no less than 2% required). Results: A total of 2,252 people with young-onset type 2 diabetes (age [mean ± SD]: 34.1 ± 4.9 years; 40.0% male) and 77,892 people with usual-onset type 2 diabetes (age [mean ± SD]: 64.9 ± 11.0 years; 51.4% male) were included in this analysis. The 2-class solution and 1-class solution were chosen as the most appropriate models for young-onset and usual-onset type 2 diabetes respectively. A stable-increase trajectory with HbA1c rising gradually before diabetes diagnosis was identified in 96% of people with young-onset type 2 diabetes, while the other 4% had an accelerated-increase trajectory with HbA1c increasing rapidly within one year before diagnosis. People with usual-onset type 2 diabetes had HbA1c value increasing gradually before diabetes diagnosis. Conclusion: Blood glucose climbed gradually at a steady rate before diabetes diagnosis in most people with type 2 diabetes, while a small proportion of people with young-onset type 2 diabetes showed a rapid deterioration within a short period before disease onset. Disclosure Y.Fan: None. H.Wu: None. E.S.H.Lau: None. A.Yang: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company.