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Early Onset of Type 2 Diabetes and End-Stage Renal Disease

Patients with youth-onset diabetes were more likely than those with older-onset diabetes to develop end-stage renal disease.

Type 2 diabetes is known to cause cardiovascular complications. To determine whether age at diabetes onset is associated with incidence of end-stage renal disease (ESRD), researchers followed 1856 Pima Indians with type 2 diabetes between 1965 and 2002.

The participants were characterized as having youth-onset diabetes (diagnosed before age 20) or older-onset diabetes (diagnosed between ages 20 through 54). The youth-onset group had an ESRD sex-adjusted incidence rate that was 8.4 times as high as the older-onset group for ages 25 to 34, 5.4 times as high for ages 35 to 44, and 4.0 times as high for ages 45 to 54. The age-sex adjusted incidence of ESRD was 25 cases per 1000 person-years among those with youth-onset diabetes, and 3.4 cases per 1000 person years among those with older-onset diabetes. Although the relation between age of onset and incidence of ESRD was no longer significant after adjustment for many covariates, the data support a high risk for ESRD among those with early-onset type 2 diabetes.

In a comparison between the diabetic patients and 4189 nondiabetic controls, the youth-onset group had the highest death rate (18.6 per 1000 person-years), followed by the older-onset group (12.7 per 1000 person-years) and the controls (10 per 1000 person-years). In analyses adjusted for sex and age, individuals with youth-onset diabetes had a death rate that was twice as high as those with older-onset diabetes.

Comment: Although these data reflect a population known to have a high prevalence of type 2 diabetes, the results indicate that the longer patients have diabetes, the more likely they are to develop ESRD and to die from natural causes, including cardiovascular diseases. We must do all we can to stem the epidemic of type 2 diabetes in teenagers.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 23, 2006

Citation(s):

Pavkov ME et al. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA 2006 Jul 26; 296:421-6.

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