Type 2 Diabetes Hits Hard in Congenital Heart Disease – Medscape

Report on Early-Onset Type 2 Diabetes in Adults with Congenital Heart Disease and Implications for Sustainable Development Goals

Introduction and Alignment with SDG 3: Good Health and Well-being

A recent population-based cohort study presented at the 2025 Canadian Cardiovascular Congress has identified a significant health risk for adults with congenital heart disease (CHD). The research indicates that this population is susceptible to an early onset of type 2 diabetes, which is associated with a substantial increase in mortality. These findings directly address the targets of Sustainable Development Goal 3 (Good Health and Well-being), which aims to reduce premature mortality from non-communicable diseases through prevention and treatment. The study underscores the urgent need for enhanced screening protocols and proactive healthcare management for this vulnerable group to ensure healthy lives and promote well-being.

Key Research Objectives and Methodology

The study, conducted by researchers at McGill University, was guided by three primary objectives:

1. To calculate the incidence rate of type 2 diabetes in the adult CHD population and compare it with the general population, including an analysis based on the severity of cardiac lesions.
2. To identify the specific predictors of early-onset type 2 diabetes (diagnosed by age 40 or earlier) in adults with CHD.
3. To assess the association between the early onset of type 2 diabetes and all-cause mortality within this patient cohort.

The investigation utilized the Quebec Congenital Heart Disease Database, analyzing data from 1983 to 2017 for 84,253 adults with CHD who developed type 2 diabetes. A propensity-score matched analysis was employed to control for confounding variables and accurately assess survival outcomes.

Principal Findings and Health Disparities (SDG 10: Reduced Inequalities)

The research revealed significant disparities in health outcomes, a key concern of Sustainable Development Goal 10 (Reduced Inequalities). The incidence of type 2 diabetes was markedly higher in the CHD cohort compared to the general Canadian population across multiple age groups. This inequality was further pronounced within the CHD group itself.

• Age 20-34: Incidence was 1.88 per 1000 person-years in the CHD group vs. 1.40 in the general population.
• Age 50-64: Incidence was 13.84 per 1000 person-years in the CHD group vs. 11.08 in the general population.
• Age 65-79: Incidence was 23.37 per 1000 person-years in the CHD group vs. 15.14 in the general population.
• Disease Severity: Among young adults (age 20-34), those with more severe CHD had a higher diabetes incidence than those with milder disease (2.47 vs. 1.80 per 1000 person-years).

Gender-Specific Vulnerabilities (SDG 5: Gender Equality)

An unexpected finding of the study directly relates to Sustainable Development Goal 5 (Gender Equality). The analysis, which excluded patients with gestational diabetes, identified male sex as a highly protective factor (Hazard Ratio: 0.69) against developing early-onset type 2 diabetes. This suggests that women with CHD, particularly those of reproductive age with moderate-to-severe conditions, face a disproportionately higher risk. This gender-based health disparity highlights the need for targeted research and clinical strategies to ensure equitable health outcomes for women.

Mortality Impact and Call to Action

The study confirmed a strong link between early-onset diabetes and premature mortality, reinforcing the importance of achieving SDG 3. Survival rates were significantly lower for individuals who developed type 2 diabetes by age 40. The mortality hazard ratio was 2.5 times higher in patients with early-onset diabetes (HR 4.19) compared to those with late-onset disease (HR 1.65). Predictors for early-onset diabetes included:

• Chronic liver and kidney disease
• Obesity
• Dyslipidemia
• Hypertension

These results constitute a clear call to action for the global health community to implement earlier and more frequent diabetes screening for all adult patients with congenital heart disease.

Conclusion: Advancing Health Equity through Collaborative Research

This study provides critical evidence that adults with CHD are a high-risk population for early-onset type 2 diabetes and associated mortality, with women facing a particular vulnerability. The findings underscore the interconnectedness of the Sustainable Development Goals, demonstrating that progress in SDG 3 (Good Health and Well-being) is contingent upon addressing the disparities highlighted in SDG 10 (Reduced Inequalities) and SDG 5 (Gender Equality). The research, funded by a Canadian Institute of Health Research grant, also exemplifies the importance of SDG 17 (Partnerships for the Goals), as such collaborative efforts are essential for generating the data needed to inform policy and clinical practice to achieve health equity for all.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   The primary Sustainable Development Goal (SDG) addressed in the article is:

   • SDG 3: Good Health and Well-being. This goal aims to ensure healthy lives and promote well-being for all at all ages. The article directly relates to this by focusing on non-communicable diseases (NCDs) like type 2 diabetes and congenital heart disease. It investigates disease incidence, mortality rates, and identifies a vulnerable population (adults with congenital heart disease) that requires better health monitoring and care, which are central themes of SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

   Based on the article’s focus, the following specific SDG target can be identified:

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
     • Explanation: The article’s core finding is that early-onset type 2 diabetes significantly increases mortality in patients with congenital heart disease. The study quantifies this premature mortality with a hazard ratio of 4.19. The conclusion that there is a “need to screen for diabetes earlier” is a direct call for improved prevention and treatment strategies to reduce this mortality, aligning perfectly with the objective of Target 3.4.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   Yes, the article mentions and implies several quantitative indicators that can be used to measure progress towards Target 3.4.

   • Mortality Rate / Hazard Ratio: The article explicitly mentions the “mortality hazard ratio (HR)” as a key finding, stating it was “2.5 times higher in patients with early-onset diabetes (HR, 4.19) than in those with those with late-onset disease (HR, 1.65).” This directly measures the risk of premature mortality from NCDs in a specific population, serving as a powerful indicator for Target 3.4.
   • Incidence Rate of a Non-Communicable Disease: The study’s first objective was to “calculate the incidence rate of type 2 diabetes mellitus.” It provides specific data, such as the incidence being higher in the congenital heart disease group for patients aged 20-34 years (1.88 vs 1.40 per 1000 person-years). This indicator measures the prevalence and spread of an NCD, which is crucial for tracking prevention efforts under Target 3.4.
   • All-Cause Mortality: One of the study’s stated objectives was to “assess the association between early-onset diabetes and all-cause mortality.” This is a fundamental health indicator used to evaluate the overall impact of diseases and the effectiveness of healthcare interventions aimed at reducing premature deaths.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-being	Target 3.4: Reduce premature mortality from non-communicable diseases (NCDs) through prevention and treatment.	Mortality Hazard Ratio (HR): The study found an HR of 4.19 for early-onset diabetes, quantifying the risk of premature death. Incidence Rate of Type 2 Diabetes: The article reports specific rates (e.g., 1.88 per 1000 person-years) for the congenital heart disease population. All-Cause Mortality: The study assessed the link between early-onset diabetes and all-cause mortality.

Source: medscape.com