Type 1 vs. type 2 diabetes accelerates kidney disease degeneration
South Korean adults with chronic kidney disease are more likely to progress to end-stage renal disease if they have type 1 diabetes vs. type 2 diabetes, and the presence of metabolic syndrome further increases the odds, according to findings published in Diabetes/Metabolism Research and Reviews.
“Despite advances in care for [type 1 diabetes] patients with impaired kidney function — including tools for glycemic control, blood pressure management and the renin-angiotensin system blockers — the incidence of ESRD caused by [type 1 diabetes] has not decreased during the past 20 years in the United States,” Jae Hyeon Kim, MD, PhD, a clinical assistant professor in the department of endocrinology and metabolism at the Samsung Medical Center of Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “However, information on ESRD risk for [type 1 diabetes] patients in Korea is limited.”
Kim and colleagues examined the potential progression to ESRD in 2,429,485 adults with an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 who underwent biannual medical examinations between 2009 and 2016. Data were pulled from the Korean National Health Insurance Service, and ESRD diagnoses were confirmed in medical claims records during an average follow-up of 4.4 years. Among the total cohort, 1,945,433 participants did not have diabetes (mean age, 57.29 years; 57.96% women), 480,543 had type 2 diabetes (mean age, 66.28 years; 53.79% women) and 3,508 had type 1 diabetes (mean age, 64.82 years; 51.57% women).
The researchers reported that 43,693 individuals presented with ESRD during follow-up. A higher percentage of those with type 1 diabetes had the ESRD (11.35%) vs. those with type 2 diabetes (4.53%) and those without diabetes (1.11%; P < .0001 for all), according to the researchers, who added that those with type 1 diabetes also had a higher incidence rate (2,928.14 per 100,000 person-years) compared with those with type 2 diabetes (1,126.12 per 100,000 person-years) and those without the disease (245.67 per 100,000 person-years). In fact, those with type 1 diabetes were more than nine times as likely to progress to ESRD than those without diabetes (OR = 9.267; 95% CI, 8.378-10.251) while the odds were more than doubled vs. those with type 2 diabetes (OR = 2.58; 95% CI, 2.336-2.849) based on fully adjusted models, which included eGFR and cardiovascular complications such as stroke and atrial fibrillation among the considerations. This model also illustrated that ESRD was more than three times as likely to be present for an individual with type 2 diabetes compared with someone without any form of diabetes (OR = 3.642; 95% CI, 3.558-3.728).
When including metabolic syndrome into the analysis, participants with type 1 diabetes who had the syndrome were twice as likely to be diagnosed with ESRD compared with those who did not have metabolic syndrome (OR = 2.023; 95% CI, 1.501-2.727), the researchers wrote. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.