Analysis of mortality risk and influencing factors in female patients with young-onset type 2 diabetes

Objective: To explore all-cause mortality risk and its influencing factors in female patients with young-onset type 2 diabetes mellitus (YOD). Methods: This cohort study included 5,984 female patients diagnosed with type 2 diabetes mellitus (T2DM) who were registered in the National Basic Public Health Service Management Program between December 2013 and January 2014 in Qinghe District (now Qingjiangpu District) and Huai'an District, Huai'an City, Jiangsu Province, China. All-cause mortality data were obtained by comprehensive matching with the Huai'an city Resident Mortality Database as of December 31, 2024. All patients were divided into four groups according to age of onset and menopause status: the young menopausal group (YM), the young premenopausal group (YP), the nonyoung menopausal group (NYM), and the nonyoung premenopausal group (NYP). Multivariate Cox regression analysis was used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for all-cause mortality risk during the follow-up period. Results: 1) A total of 5984 T2DM patients, comprising 387 YOD patients and 5597 late-onset T2DM patients (LODs), with an average age of 61.77 ± 9.87 years, were included. During the ten-year follow-up, 1293 deaths were recorded, with an all-cause mortality rate of 21.6%. The mortality rate of YOD was lower than that of LOD. 2) Subgroup analysis revealed that NYM had the highest all-cause mortality rate at 24%, followed by YM at 15%, and YP had the lowest mortality rate at 3.7%. The cumulative survival curve indicated that the YM group had the lowest survival curve, followed by the NYM group, and the YP group had the highest survival curve. 3) Multivariate Cox regression analysis revealed that the triglyceride-glucose-body mass index (TyG-BMI) was an independent protective factor for the YM group (HR = 0.980, 95% CI = 0.965-0.997) (P = 0.018). For every one standard deviation increase in the TyG-BMI, the mortality risk decreased by 2%. UA was a common risk factor for all-cause mortality in women with different ages of onset before and after menopause. Conclusion: In this study, the overall all-cause mortality rate for YOD patients was lower than that for LOD patients. However, postmenopausal women with YOD have greater all-cause mortality than premenopausal women with LOD do, and their risk of death decreases with increasing TyG-BMI. Therefore, early identification and intervention of TyG-BMI levels in postmenopausal women with YOD may help identify high-risk individuals and guide early intervention.