Early-onset type 2 diabetes linked to later end-stage renal disease

Investigators compared the incidence of diabetic end-stage renal disease (ESRD) and mortality in persons with youth-onset (i.e., younger than 20 years) and older-onset (20 to 55 years) type 2 diabetes mellitus. The study was conducted in Pima Indians of Arizona, in whom the incidence and prevalence of type 2 diabetes are high. In addition, kidney disease is a major complication of diabetes in this population: 93% of cases of ESRD in Pima Indians are attributable to the disease. Participants in the longitudinal study, begun in 1965, were subject to a research examination approximately every two years that included measurement of the venous plasma glucose concentration and assessment for complications of diabetes.

Among the 1,856 diabetic participants in the study (767 men, 1,089 women), 96 had youth-onset type 2 diabetes and 1,760 had older-onset disease. During follow-up, 148 participants progressed to ESRD-16% of those who had youth-onset disease and 8% with older-onset diabetes. The sex-adjusted incidence of ESRD was 8.4 times higher in youth-onset diabetes than it was in older-onset diabetes among subjects 25 to 34 years old; 5.0 times higher in youth-onset diabetes among those 35 to 44 years old; and 4.0 times higher in youth-onset diabetes among those 45 to 54 years old. The age- and sex-adjusted ESRD incidence in youth-onset diabetes was 25 cases for every 1,000 person-years, compared with 5.4 cases for every 1,000 person-years in older-onset diabetes.

To further explore differences in outcomes between the youth-onset and older-onset groups, investigators computed the death rate in the two groups and compared them with those of the 4,189 nondiabetic study participants. The age- and sex-adjusted death rate in participants with youth-onset diabetes was 2.1 times as high as the rate in participants with older-onset diabetes and 3.0 times as high as the rate in nondiabetic subjects. The death rate in participants with older-onset diabetes was 1.4 times as high as the rate in the nondiabetic participants (Pavkov ME et al: JAMA 2006;296:421).