Signs of Nephropathy May Occur Early in Young Adults With Diabetes Despite Modern Diabetes Management

Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS)

  1. Maria Svensson, MD1,
  2. Göran Sundkvist, MD, PHD2,
  3. Hans J. Arnqvist, MD, PHD3,
  4. Elisabeth Björk, MD, PHD4,
  5. Göran Blohmé, MD, PHD5,
  6. Jan Bolinder, MD, PHD6,
  7. Marianne Henricsson, MD, PHD7,
  8. Lennarth Nyström, PHD8,
  9. Ole Torffvit, MD, PHD9,
  10. Ingeborg Waernbaum, MSC8,
  11. Jan Östman, MD, PHD6 and
  12. Jan W. Eriksson, MD, PHD1
  1. 1Department of Medicine, Umeå University Hospital, Umeå, Sweden
  2. 2Department of Endocrinology, Malmö University Hospital, Malmö, Sweden
  3. 3Department of Medicine, Linköping University Hospital, Linköping, Sweden
  4. 4Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
  5. 5Department of Medicine, South Hospital, Stockholm, Sweden
  6. 6Center of Metabolism and Endocrinology, Huddinge University Hospital, Stockholm, Sweden
  7. 7Department of Ophthalmology, Helsingborg Hospital, Helsingborg, Sweden
  8. 8Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden
  9. 9Department of Medicine, Lund University Hospital, Lund, Sweden
  1. Address correspondence and reprint requests to Dr. Maria Svensson, Department of Medicine, Umeå University Hospital, S-90185 Umeå, Sweden. E-mail: maria.svensson{at}medicin.umu.se

Abstract

OBJECTIVE—To estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure.

RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden aims to register all incident cases of diabetes in the age-group 15–34 years. In 1987–1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186).

RESULTS—During the follow-up time, median 9 years (range 6–12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA1c during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure.

CONCLUSIONS—Despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA1c, high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 12, 2003.
    • Received October 9, 2002.
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  1. doi: 10.2337/diacare.26.10.2903 Diabetes Care October 2003 vol. 26 no. 10 2903-2909
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