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.

中文翻译：

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年轻成人发病的 2 型糖尿病与 1 型糖尿病：肾脏替代治疗的进展和生存

背景

早发型 2 型糖尿病是一种侵袭性疾病，其特征是在病程早期出现糖尿病并发症，包括肾病。然而，在年轻发病的 1 型和 2 型糖尿病队列中，关于进展为需要肾脏替代治疗或肾脏相关死亡 (RRT/RRD) 的 ESKD 的比较数据有限。

方法

对来自 RPAH 糖尿病中心、国家死亡指数以及澳大利亚和新西兰透析和移植登记处的数据进行了概率关联。累积发病率竞争风险和 Cox 比例风险建模方法用于检查年轻发病的 1 型和 2 型糖尿病（诊断年龄 15-35 岁）进展为 ESKD。

发现

在年轻发病的 1 型和 2 型糖尿病中未调整的 RRT/RRD 发生率 (95% CI) 分别为每 1000 人年 3.1 (2.3-4.0) 和 4.6 (3.7-5.7)。在对性别、种族和糖尿病病程进行调整后，年轻发病 2 型糖尿病患者 RRT/RRD 的 HR (95% CI) 为 2.0 (1.4-2.9)。在进一步调整首次可用胆固醇、HbA1c 和收缩压而非 BMI 后，HR 仍然较高。对于进展为 RRT 的患者，无论糖尿病类型如何，预后都相似；在透析 6 年后，年轻发病的 1 型和 2 型糖尿病的累积死亡率为 40%。

解释

年轻发病的 2 型糖尿病患者向 RRT/RRD 的进展要大于年轻发病的 1 型糖尿病患者。增加的进展与增加的BMI相关。然而，一旦达到 ESKD，年轻发病的 1 型和 2 型糖尿病患者的表现同样不佳。