Assessment of Cardiovascular Risk Factors,  Dietary Patterns & Physical Activity Level among People with Young Onset Diabetes in a Tertiary Care Setting in Sri Lanka

Introduction: Globally, there is a rising trend in young-onset diabetes (YOD) prevalence, with type 1 diabetes (T1DM) contributing to the majority. However, in recent years, type 2 diabetes (T2DM) has had a notable impact on YOD prevalence. Diabetes is considered a cardiovascular disease equivalent.   This is further compounded by obesity-associated insulin resistance (IR). With the increasing prevalence of YOD and longer life expectancy, assessing and addressing cardiovascular disease (CVD) risk in this population has gained importance. In this study, we aimed to determine the presence of CVD risk  factors in a YOD population.
Methods: A descriptive, cross-sectional study was carried out among people with YOD attending a specialised clinic in a tertiary care centre. Traditional CVD risk factors, including anthropometric measures and exercise and dietary habits, were assessed. Data analysis was done using SPSS.
Results: The study included 95 participants, 54.7% (n=52) females, with a mean age of 23.8 ± 6.2 years and an average diabetes duration of 7.0 ± 5.9 years. Among the participants, 63% had T1DM, and 24% had T2DM. The mean age of disease onset was 17.0 ± 4.5 years. The prevalence of microvascular complications was as follows: retinopathy 12.7% (n=12), nephropathy 5.3% (n=5), and neuropathy 4.7% (n=4). One patient(1%) had ischemic heart disease.
The population’s mean BMI was 21.59± 4.58 kg/m², with 12%(n=11) overweight and 25%(n=24)obese participants. In the population, 34% (n=32)) had dyslipidemia, 10%(n=9)  had hypertension, and 7%(n=6)  were smokers.
A total of 78% (n=18) of T2DM patients and 16.7% (n=10) of T1DM patients were classified as either overweight or obese. Both males and females with T2DM had higher waist circumference (WC) and waist-to-height ratios (WHR) compared to their specific gender with T1D  (p<0.05).   Among T1DM patients, females had higher WC and WHR than males. However, only female T2DM patients exceeded the safe thresholds for WC and WHR. Per centage, prevalence of anthropometric risk factors,high LDL and Low HDL were highest in females with T2DM; the average daily intake of carbohydrates was 214g. The contribution of carbohydrates to the daily macronutrient content in the diet was 62% in T1DM and 76% in T2DM. Despite 71% of the population consuming vegetables daily, only a quarter of the participants consumed fruit. None of the study participants met the daily recommended physical activity levels.
Conclusion: While the prevalence of anthropometric risk factors for cardiovascular disease is higher in T2DM patients, it is also prevalent in a significant proportion of T1DM patients, with a female predominance in both groups. Additionally, the study's findings underscore the importance of addressing lifestyle factors like diet and exercise and optimising cardiovascular risk reduction strategies in YOD populations to tackle the CVD risk regardless of the type of diabetes.