Early type 2 diabetes diagnosis drives long-term kidney disease risk
Adults diagnosed with type 2 diabetes before age 30 years are more likely to develop renal failure over time compared with those with a shorter diabetes duration, according to a database analysis published in Diabetes Care.
“There is a widely held belief that younger-onset type 2 diabetes has a more aggressive trajectory and that it ultimately leads to considerably higher risk for complications because of some innate difference in pathophysiology,” Jedidiah I. Morton, a doctoral student at the Baker Heart and Diabetes Institute and the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, told Healio. “However, robust evidence for this hypothesis is lacking, particularly with important endpoints of microvascular complications. End-stage renal disease is such an endpoint and is associated with significant costs and burden. The prevailing view is that the risk for renal failure is generally low in type 2 diabetes, but no study to date had evaluated the very long-term risk. Therefore, we sought to quantify the long-term risk of ESRD for people with type 2 diabetes and how this varies by the age of onset of diabetes.”
Morton and colleagues analyzed data from 1,113,201 adults with type 2 diabetes registered with the Australian National Diabetes Services Scheme and followed from 2002 until 2013 (median age of diabetes onset, 58 years). Researchers linked the data with the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index.
Between 2002 and 2013, there were 7,592 incident cases of ESRD and 192,005 deaths during 7,839,075 person-years of follow-up.
During the first 10 to 15 years after diabetes onset, the incidence of ESRD was highest among those with an older age of onset of diabetes; however, over longer durations of diabetes, the incidence of ESRD became higher among those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESRD was 11.8% and 9.3% in those diagnosed with diabetes aged 10 to 29 years and aged 30 to 39 years, respectively.
When death from ESRD without renal replacement therapy was included, the incidence of ESRD remained higher among those with older-onset diabetes for the initial 20 years, with no clear effect of age thereafter.
“The risk of ESRD at long durations of type 2 diabetes is much higher than might be expected based on previous studies,” Morton said. “This risk disproportionately affects those who are younger at onset of type 2 diabetes, as they are more likely to survive to longer durations. Moreover, when compared with older-onset, younger-onset of type 2 diabetes carries no additional risk for ESRD beyond the effects of attaining longer durations of diabetes.”
Morton noted that the study was performed with data collected before the widespread use of SGLT2 inhibitors, which, given their substantial renoprotective effects, would be expected to decrease the cumulative incidence of ESRD for people with type 2 diabetes.
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Jedidiah Morton can be reached at the Baker Heart and Diabetes Institute, 75 Commercial Road, P.O. Box 6492, Melbourne, Victoria, 3004 Australia; email: email@example.com; Twitter: @JedidiahMorton.