Early-Onset Diabetes in Lahore and Kasur Districts of Punjab: A Hospital-Based Study

Background: Early-onset diabetes is increasing in South Asia, but the distribution and correlates of diabetes types among young Pakistani patients are poorly characterized. Methods: This cross-sectional study at five tertiary-care hospitals in Lahore and Kasur, Pakistan, included 856 patients with type 1 or type 2 diabetes diagnosed at or before 40 years of age, grouped by age at diagnosis (1–10, 11–20, 21–30, and 31–40 years). Factors associated with clinically assigned type 1 diabetes were examined using Firth penalized logistic regression adjusted for age at diagnosis, gender, BMI category, first-degree family history, parental consanguinity, and physical activity. Results: Type 1 diabetes was assigned to 255 participants (29.8%), including 97.6% and 73.6% of those diagnosed at 1–10 and 11–20 years, compared with 21.9% and 10.4% of those diagnosed at 21–30 and 31–40 years. BMI and blood pressure were higher with later diagnosis, whereas glycemic control was uniformly poor (mean HbA1c, 9.1%; p = 0.356). Compared with diagnosis at 1–10 years, the adjusted odds of type 1 diabetes were lower with diagnosis at 11–20 years (aOR, 0.0767; 95% CI, 0.0083–0.3134), 21–30 years (aOR, 0.0083; 95% CI, 0.0009–0.0335), and 31–40 years (aOR, 0.0034; 95% CI, 0.0004–0.0144) and in females (aOR, 0.35; 95% CI, 0.24–0.51), and higher with parental consanguinity (aOR, 1.98; 95% CI, 1.36–2.91) and underweight BMI (aOR, 1.95; 95% CI, 1.04–3.70). First-degree family history (aOR, 0.94; 95% CI, 0.61–1.48) and physical activity (aOR, 1.35; 95% CI, 0.92–1.98) were not associated with diabetes type. The optimism-corrected area under the curve was 0.846. Conclusions: Clinically assigned diabetes type differed sharply by age at diagnosis and was independently associated with gender, parental consanguinity, and underweight BMI.