1628-P: Extreme Survival in a Low SES Population with Early-Onset Diabetes

Abstract

Low-income African Americans (AA) and Whites with extreme duration of young-onset diabetes (YODM) are a unique population. Traits of this population surviving w/DM for 50 yrs can provide clues to longevity in YODM, particularly in the poor and underserved. Persons ≥50 yrs old (59% female, 60% AA) from the Southern Community Cohort Study diagnosed w/DM < age 30 (n=649), classified by DM duration ≥ 50 yrs (extreme duration, n=96) or <50 yrs (shorter duration, n=553), or w/o DM (n=33,939) at cohort entry were included. We used multinomial logistic regression (OR, 95% CI) to compare traits across groups and Cox models (HR, 95% CI) to assess mortality risk and factors linked w/survival after cohort entry. Mean age was 63, 54, and 57 in those w/extreme, shorter and no DM, respectively. Mean age at DM diagnosis was 5 and 23 in those w/extreme and shorter duration. Compared to shorter duration, those w/extreme duration had a lower BMI at age 21 (OR=0.93, 0.89-0.98) but higher BMI (OR=1.04, 1.01-1.08) at study entry. They were 40 to 50% less likely to have glaucoma and cataracts, but no difference in hx of stroke or CAD. By contrast, they had 1.5 to 3-fold greater risk vs. those w/o DM. In Cox models, those w/shorter duration YODM were at 3.2 times greater mortality risk vs. those w/o DM (HR=3.23, 2.76-3.77), but risk increased only marginally in extreme duration vs. those w/o DM (HR=1.39, 0.98-1.98). No racial difference in survival was seen in extreme (HR=1.04, 0.39-2.77) or shorter duration DM (HR=1.04, 0.72-1.49), though AA w/o DM were at slightly increased mortality risk vs. Whites (HR=1.09, 1.03-1.16). In YODM, diagnosis before age 6 was linked w/lower mortality (HR=0.57, 0.33-0.96) vs. those ≥ age 6. This low-income population w/extreme duration of YODM diagnosed mainly in very early childhood is characterized by a relatively lean BMI in young-but not later adulthood, and appear relatively protected from certain DM and age-related complications. Our data also suggests that in the low SES, AA are not any less likely to survive ≥50 yrs w/DM than Whites. Disclosure E. Campos: None. H.A. Keenan: None. M.F. Lopes-Virella: None. W.J. Blot: None. B. Conway: None. Funding 5U01CA202979-04