Young People with Type 2 Diabetes More Likely to Have Kidney Failure
Receiving a diagnosis of type 2 diabetes before a person turns 20 years of age seriously increases the risk of kidney failure and death, according to a report in the Journal of the American Medical Association (JAMA).
The study, which includes nearly 40 years of information from a Southwestern Indian tribe, found that the rate of serious kidney disease occurring before the age of 35 was more than eight times higher in people diagnosed with type 2 diabetes before they were 20, compared with those who were diagnosed between 20 and 55 years of age.
Additionally, the study found that people diagnosed with type 2 diabetes early in life had a death rate between the ages of 25 and 55 that was twice as high as that of people diagnosed later in life.
"The frequency of ESRD [end-stage renal disease] is nearly fivefold higher during mid-life among those diagnosed with diabetes in youth," says study researcher Dr. Robert G. Nelson, at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
"This observation has profound implications not only for this population, but for others since type 2 diabetes is being diagnosed with increasing frequency among children and adolescents in many different populations. Diabetes in youth is not something to be taken lightly."
In type 2 diabetes, the body does not produce enough of the hormone insulin or the cells ignore the insulin. Insulin is necessary for the body to metabolize sugar for energy.
Besides kidney disease, complications from type 2 diabetes include heart disease, blindness, and nerve damage, according to the American Diabetes Association.
More than 100,000 Americans are diagnosed with kidney failure or ESRD every year, according to the NIDDK.
About 45 percent of those cases are caused by diabetes. For people with kidney failure, two treatment options exist - dialysis or kidney transplant.
Fortunately, not everyone who has diabetes will develop kidney failure. However, Native Americans, African Americans, and Hispanics with diabetes have higher rates of kidney failure from the disease, state experts.
Beginning in 1965, members of a Southwestern Native American tribe were asked to participate in a long-term study of type 2 diabetes and its complications.
Every two years, whether they were healthy or ill, the study participants underwent a thorough health exam, including blood glucose measurements.
More than 1,800 people with diabetes participated in the study and results through 2002 were included in the current analysis. Ninety-six people were diagnosed with ESRD before they were 20 years old.
Overall, those diagnosed in their youth had about a fivefold increase in the incidence of ESRD in middle age, compared to those diagnosed at an older age.
Specifically, the youth-onset group was 8.4 times more likely to have ESRD between 25 and 34 than those diagnosed after 20.
The youth-onset group was also five times more likely to have ESRD between 35 and 44, and four times more likely to have the condition between the ages of 45 and 54 than those diagnosed at an older age.
In addition, the death rate was significantly higher for the early-onset group.
Between the ages of 25 and 55, 15.4 deaths per 1,000 person years occurred in the youth-onset group, while only 7.3 deaths per 1,000 person years occurred in the group diagnosed after age 20.
Dr. Nelson says the study authors believe the primary reason for the increase in ESRD and mortality is simply that the youth-onset group had diabetes for a longer period of time.
Dr. Stuart Weiss, an endocrinologist at New York University Medical School, says, "Given the fact that there is more and more and younger and younger type 2 diabetes, this study should send up a little bit of an alarm. But I don't know that we can say for sure this is what will happen in every population."
Dr. Kirit Tolia, medical director of the Joslin Diabetes Center at Providence Hospital in Southfield, Mich., says he believes the findings would be similar in other groups of people, and points to the need to prevent or at least delay the onset of diabetes.
"Prevention of early diabetes, that's the key," Dr. Tolia says. "This is where lifestyle modifications come in. Maintain your ideal body weight and exercise."
Dr. Nelson adds, "Modest exercise, performed routinely, can substantially lower the risk of diabetes."
If you already have diabetes, all three experts said that maintaining tight control of your blood pressure and blood sugar is extremely important for preventing complications.
"Control of blood pressure and blood sugar is the best way to reduce the risk of diabetic complications,” notes Dr. Nelson. “This sounds simple enough, but it can be hard to do. Newer medicines make it easier to do than in the past.”
Always consult your physician for more information.
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Nephropathy is the deterioration of the kidneys. The final stage of nephropathy is called end-stage renal disease, or ESRD.
Diabetes is the most common cause of ESRD, accounting for more than 43 percent of cases.
About 17 million people in the US have diabetes, and more than 100,000 people have ESRD as a result of diabetes.
Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.
There are five stages of diabetic nephropathy, or deterioration of the kidneys.
The fifth stage is ESRD. Progress from one stage to the next can take many years, with 23 years being the average length of time to reach stage five.
Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy.
Hypertension is believed to be both the cause of diabetic nephropathy, as well as the result of damage that is created by the disease.
As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.
Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.
The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.
Always consult your physician for more information.
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