The Effect of Glycemic Control on Cardiovascular Disease Progression in Adults With Early-Onset Type 2 Diabetes: A Longitudinal Cohort Analysis

Introduction Rising prevalence rates of type 2 diabetes mellitus (T2DM), particularly in younger populations, have made early-onset T2DM (diagnosed before age 40) an increasingly significant health concern. Early-onset T2DM is often associated with more rapid progression and increased complications, including cardiovascular disease (CVD). However, its specific impact on cardiovascular outcomes remains inadequately understood, particularly compared to T2DM in older populations. This study aimed to assess how glycemic management affects the course of CVD in individuals with early-onset T2DM. Methodology During the six months between December 2, 2023, and August 5, 2024, a longitudinal cohort study was carried out at Ayub Teaching Hospital in Abbottabad. In total, 470 adults with early-onset T2DM were included in the study cohort after applying exclusion criteria. Participants were classified into two groups based on glycated hemoglobin (HbA1c) values: those with HbA1c ≤ 7% and those with HbA1c > 7%. Using SPSS version 27 (IBM Corp., Armonk, NY, US), data were analyzed as follows: Baseline characteristics were compiled using descriptive statistics, with mean and standard deviation for continuous variables and frequencies for categorical variables. Time to cardiovascular events relative to glycemic control levels was assessed using Kaplan-Meier survival analysis. To examine the relationship between HbA1c levels and the risk of CVD development, Cox proportional hazards models were employed, adjusting for potential confounders such as age, sex, diabetes duration, BMI, and lipid profile. Differences in continuous variables were analyzed using two-sample t-tests, with p-values < 0.05 considered statistically significant. Results This study assessed the impact of glycemic management on CVD progression in individuals with early-onset T2DM. A total of 470 participants were included, with those having HbA1c > 7% showing a significantly higher risk for cardiovascular events (hazard ratio: 1.88, 95% CI: 1.25-2.85, p < 0.01). Participants with higher HbA1c levels also exhibited worse lipid profiles, including elevated LDL cholesterol (130.4 mg/dL vs. 115.2 mg/dL, p < 0.01) and triglycerides (178.6 mg/dL vs. 150.7 mg/dL, p < 0.01), along with increased blood pressure. These findings highlight the critical role of glycemic control in CVD risk, particularly in younger populations with early-onset T2DM. Conclusion Maintaining HbA1c levels below 7% is crucial for reducing cardiovascular risk in individuals with early-onset T2DM. This study highlights the importance of comprehensive management strategies that focus on glycemic control, lipid regulation, and blood pressure management. These strategies should be implemented through evidence-based interventions, such as lifestyle modifications (e.g., dietary changes, physical activity), pharmacological treatments (e.g., metformin, statins, antihypertensive medications), and regular monitoring to improve cardiovascular outcomes. While the findings are based on a cohort from Ayub Teaching Hospital, they are likely relevant to similar populations with early-onset T2DM, though generalizability to other regions or healthcare settings should be considered with caution.