Age at Diagnosis and the Risk of Diabetic Nephropathy in Young Patients with Type 1 Diabetes Mellitus

• Published in: Diabetes & metabolism journal Vol. 45; no. 1; pp. 46 - 54
• Main Authors: Baek, Jong Ha, Lee, Woo Je, Lee, Byung-Wan, Kim, Soo Kyoung, Kim, Gyuri, Jin, Sang-Man, Kim, Jae Hyeon
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Diabetes Association / Daehan Dangnyobyeong Hakoe 01.01.2021; Korean Diabetes Association; 대한당뇨병학회
• Subjects: Adolescent; Adult; Age; Aged; Antidiabetics; Blood pressure; Body mass index; Cardiovascular disease; Child; Childhood; Creatinine; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - epidemiology; Diabetic nephropathy; Diabetic neuropathy; Drug dosages; Epidemiology; Fasting; Glucagon; Glucose; Humans; Insulin; Kidney diseases; Kidney Function Tests; Mortality; Odds Ratio; Original; Peptides; Regression analysis; Teenagers; Variance analysis; Young Adult; 내과학; Diabetes complications; Diabetes mellitus, type 1; Diabetic nephropathies
• ISSN: 2233-6079; 2233-6087; 2233-6087
• DOI: 10.4093/dmj.2019.0134

The aim of this study was to evaluate characteristics and risk of diabetic complications according to age at diagnosis among young adults with type 1 diabetes mellitus (T1DM). A total of 255 T1DM patients aged less than 40 years were included. Patients were categorized into three groups (<20, 20 to 29, and 30 to 40 years) according to age at diagnosis. Diabetic nephropathy (DN) was defined when spot urine-albumin creatinine ratio was 300 mg/g or more and/or estimated glomerular filtration ratio (eGFR) level was 60 mL/min/1.73 m2 or less. Median age at diagnosis was 25 years and disease duration was 14 years. Individuals diagnosed with T1DM at childhood/adolescent (age <20 years) had lower stimulated C-peptide levels. They received more intensive insulin treatment with higher total daily insulin doses compared to older onset groups. The prevalence of DN was higher in the childhood/adolescent-onset group than in older onset groups (25.3% vs. 15.3% vs. 9.6%, P=0.022). The eGFR was inversely associated with disease duration whilst the degree of decrease was more prominent in the childhood/adolescent-onset group than in the later onset group (aged 30 to 40 years; P<0.001). Childhood/adolescent-onset group was independently associated with the risk of DN compared to the older onset group (aged 30 to 40 years; odds ratio, 3.47; 95% confidence interval, 1.45 to 8.33; P=0.005). In individuals with childhood/adolescent-onset T1DM, the reduction in renal function is more prominent with disease duration. Early age-onset T1DM is an independent risk of DN.