High Burden of Kidney Disease in Youth-Onset Type 2 Diabetes
- Allison B. Dart, MD1⇓,
- Elizabeth A. Sellers, MD1,
- Patricia J. Martens, PHD2,
- Claudio Rigatto, MD3,
- Marni D. Brownell, PHD2 and
- Heather J. Dean, MD1
- 1Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- 2Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
- 3Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Corresponding author: Allison B. Dart, .
OBJECTIVE To evaluate renal outcomes and survival in youth with type 2 diabetes (T2DM) versus type 1 diabetes (T1DM) versus nondiabetic control subjects.
RESEARCH DESIGN AND METHODS In total, 342 prevalent youth (aged 1–18 years) with T2DM, 1,011 youth with T1DM, and 1,710 control subjects identified from 1986 to 2007 were anonymously linked to health care records housed at the Manitoba Centre for Health Policy to assess long-term outcomes using ICD codes.
RESULTS Youth with T2DM were found to have a fourfold increased risk of renal failure versus youth with T1DM. Risk factors associated with renal failure were renin angiotensin aldosterone system inhibitor use and albuminuria in adolescence. Compared with control subjects (age, sex, and postal code matched), youth with T2DM had a 23-fold increased risk of renal failure and a 39-fold increased risk of dialysis. Kaplan-Meier survival at 10 years was 91.4% in the type 2 diabetic group versus 99.5% in the type 1 diabetic group (P < 0.0001). Renal survival was 100% at 10 years in both groups. It decreased to 92.0% at 15 years and 55.0% at 20 years in the type 2 diabetic group but remained stable in the type 1 diabetic group (P < 0.0001).
CONCLUSIONS Youth with T2DM are at high risk of adverse renal outcomes and death. Albuminuria and angiotensin aldosterone system inhibitor use, which may be a marker of severity of disease, are associated with poor outcomes in early adulthood.
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The results and conclusions are those of the authors, and no official endorsement by the MCHP, Manitoba Health, or other data providers is intended or should be inferred.
- Received November 29, 2011.
- Accepted February 9, 2012.
- © 2012 by the American Diabetes Association.
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