Young adult onset type 2 diabetes versus type 1 diabetes: Progression to and survival on renal replacement therapy

• Published in: Journal of diabetes and its complications Vol. 35; no. 11; p. 108023
• Main Authors: Middleton, Timothy L., Chadban, Steven, Molyneaux, Lynda, D'Souza, Mario, Constantino, Maria I., Yue, Dennis K., McGill, Margaret, Wu, Ted, Twigg, Stephen M., Wong, Jencia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Adolescent; Adult; Age; Australia - epidemiology; Cholesterol; Diabetes; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Dialysis; Ethnicity; Gender; Hemodialysis; Humans; Incidence; Kidney diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Mortality; Registries; Renal Replacement Therapy; Renal transplantation; Survival analysis; Survival Rate; Transplants & implants; Young Adult; Young adults; Young onset diabetes; Australia; New Zealand; Renal transplantation; Survival analysis; Dialysis; Young onset diabetes
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2021.108023

Young-onset type 2 diabetes is an aggressive disease characterized by development of diabetic complications, including nephropathy, early in the disease course. However, within the cohort of young-onset type 1 and type 2 diabetes there are limited comparative data regarding progression to ESKD requiring renal replacement therapy or renal-related death (RRT/RRD). Probabilistic linkage of data from the RPAH Diabetes Centre, National Death Index and Australian and New Zealand Dialysis and Transplant Registry was undertaken. Cumulative Incidence Competing Risk and Cox Proportional Hazards Modelling approaches were utilized to examine progression to ESKD in young-onset type 1 and type 2 diabetes (age of diagnosis 15–35 years). Unadjusted incidence rates (95% CI) of RRT/RRD in young-onset type 1 and type 2 diabetes were 3.1 (2.3–4.0) and 4.6 (3.7–5.7) per 1000 person years respectively. After adjustment for gender, ethnicity and duration of diabetes, the HR (95% CI) of RRT/RRD in young-onset type 2 diabetes was 2.0 (1.4–2.9). The HR remained higher after further adjustment for first available cholesterol, HbA1c and systolic blood pressure but not BMI. For those who progressed to RRT, prognosis was similar irrespective of diabetes type; cumulative incidence of mortality was 40% in both young-onset type 1 and type 2 diabetes after 6 years of dialysis. Progression to RRT/RRD is greater in young-onset type 2 diabetes than in young-onset type 1 diabetes. The increased progression is associated with increased BMI. However, once ESKD is reached, individuals with young-onset type 1 and type 2 diabetes do equally poorly. •Risk of progression to RRT/RRD in YT2DM is 2-fold higher than in YT1DM•Excess risk in YT2DM persists after adjustment for metabolic parameters but not BMI•Once ESRD is reached, cumulative incidence of mortality is 40% after 6 years of dialysis•On RRT the survival of patients with YT2DM and YT1DM is equally poor