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

Timothy L Middleton; Steven Chadban; Lynda Molyneaux; Mario D'Souza; Maria I Constantino; Dennis K Yue; Margaret McGill; Ted Wu; Stephen M Twigg; Jencia Wong

doi:10.1016/j.jdiacomp.2021.108023

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

J Diabetes Complications. 2021 Nov;35(11):108023. doi: 10.1016/j.jdiacomp.2021.108023. Epub 2021 Aug 19.

Authors

Affiliations

¹ Diabetes Centre, RPA Hospital, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia. Electronic address: timothy.middleton@health.nsw.gov.au.
² Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Department of Renal Medicine, RPA Hospital, Camperdown, NSW 2050, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA 5001, Australia.
³ Diabetes Centre, RPA Hospital, Camperdown, NSW 2050, Australia.
⁴ Sydney Local Health District Clinical Research Centre, Camperdown, NSW 2050, Australia.
⁵ Diabetes Centre, RPA Hospital, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia.

PMID: 34481713
DOI: 10.1016/j.jdiacomp.2021.108023

Abstract

Background: 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).

Methods: 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).

Findings: 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.

Interpretation: 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.

Keywords: Dialysis; Renal transplantation; Survival analysis; Young onset diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Australia / epidemiology
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 1* / therapy
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / therapy
Humans
Incidence
Kidney Failure, Chronic* / epidemiology
Kidney Failure, Chronic* / therapy
Registries
Renal Replacement Therapy*
Survival Rate
Young Adult