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. 2020 Mar;63(3):508-518.
doi: 10.1007/s00125-019-05044-z. Epub 2019 Dec 5.

Preterm birth and risk of type 1 and type 2 diabetes: a national cohort study

Casey Crump  1   2 , Jan Sundquist  3   4   5 , Kristina Sundquist  6   7   8
Affiliations

Preterm birth and risk of type 1 and type 2 diabetes: a national cohort study

Casey Crump et al. Diabetologia. 2020 Mar.

Abstract

Aims/hypothesis: Preterm birth (gestational age <37 weeks) has been associated with insulin resistance early in life. However, no large population-based studies have examined risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood. Clinicians will increasingly encounter adults who were born prematurely and will need to understand their long-term risks. We hypothesised that preterm birth is associated with increased risks of type 1 and type 2 diabetes into adulthood.

Methods: A national cohort study was conducted of all 4,193,069 singletons born in Sweden during 1973-2014, who were followed up for type 1 and type 2 diabetes identified from nationwide diagnoses and pharmacy data to the end of 2015 (maximum age 43 years; median age at the end of follow-up 22.5 years). Cox regression was used to adjust for potential confounders, and co-sibling analyses assessed the influence of shared familial (genetic and/or environmental) factors.

Results: In 92.3 million person-years of follow-up, 27,512 (0.7%) and 5525 (0.1%) people were identified with type 1 and type 2 diabetes, respectively. Gestational age at birth was inversely associated with both type 1 and type 2 diabetes risk. Adjusted HRs for type 1 and type 2 diabetes at age <18 years associated with preterm birth were 1.21 (95% CI, 1.14, 1.28) and 1.26 (95% CI, 1.01, 1.58), respectively, and at age 18-43 years were 1.24 (95% CI, 1.13, 1.37) and 1.49 (95% CI, 1.31, 1.68), respectively, compared with full-term birth. The associations between preterm birth and type 2 (but not type 1) diabetes were stronger among females (e.g. at age 18-43 years, females: adjusted HR, 1.75; 95% CI, 1.47, 2.09; males: 1.28; 95% CI, 1.08, 1.53; p < 0.01 for additive and multiplicative interaction). These associations were only partially explained by shared genetic or environmental factors in families.

Conclusions/interpretation: In this large national cohort, preterm birth was associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood. Preterm-born children and adults may need early preventive evaluation and long-term monitoring for diabetes.

Keywords: Adult; Diabetes mellitus, type 1; Diabetes mellitus, type 2; Gestational age; Infant, small for gestational age; Premature birth; Preterm birth.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for time to type 1 diabetes
Fig. 2
Fig. 2
Kaplan–Meier curves for time to type 2 diabetes
Fig. 3
Fig. 3
Adjusted HRs for new-onset type 1 diabetes by gestational age at birth compared with full-term birth, Sweden, 1973–2015
Fig. 4
Fig. 4
Adjusted HRs for new-onset type 2 diabetes by gestational age at birth compared with full-term birth, Sweden, 1973–2015
See this image and copyright information in PMC

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