Diabetic CKD: progression risk higher with T1D than T2D

  • Lee YB & al.
  • Diabetes Metab Res Rev
  • 21 Jun 2019

  • International Clinical Digest
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Takeaway

  • Risk for chronic kidney disease (CKD) progression to end-stage renal disease (ESRD) is higher with type 1 diabetes (T1D) vs type 2 diabetes (T2D).

Why this matters

  • This study established metabolic syndrome as a prognostic factor for progression of diabetic nephropathy in T1D.

Study design

  • Data for 2,429,485 adults with estimated glomerular filtration rate (eGFR) 2 from the Korean National Health Insurance Service.
  • 480,543 had T2D, 3508 had T1D, and 1,945,433 had no diabetes; corresponding mean ages were 66.28, 64.82, and 57.29 years.
  • Funding: None disclosed.  

Key results

  • 43,693 cases of ESRD were diagnosed over a mean of 4.40±1.76 years.
  • Incident ESRD was higher in T1D (11.35%) vs T2D (4.53%) and no diabetes (1.11%; P<.0001 for all comparisons>
  • Incidence rates per 100,000 person-years:
    • T1D: 2928.14;
    • T2D: 1126.12; and
    • No diabetes: 245.67.
  • In fully adjusted models, risk for ESRD was (adjusted HRs; 95% CIs):
    • More than doubled in T1D vs T2D: 2.580 (2.336-2.849).
    • 9-fold higher in T1D vs no diabetes: 9.267 (8.378-10.251).
    • Over 3-fold higher in T2D vs no diabetes: 3.642 (3.558-3.728).
  • Presence of metabolic syndrome doubled ESRD risk: 2.023 (1.501-2.727).

Limitations

  • Retrospective analysis.
  • HbA1c not captured.
  • Potential unmeasured confounding.

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