Declining Incidence of Nephropathy in Insulin-Dependent Diabetes Mellitus

Bojestig, Mats; Arnqvist, Hans J.; Hermansson, Göran; Karlberg, Bengt E.; Ludvigsson, Johnny

doi:10.1056/nejm199401063300103

Cited by 411 publications

(253 citation statements)

References 21 publications

Supporting

Mentioning

235

Contrasting

Unclassified

Order By: Relevance

“…In the Linköping Diabetes Complications Study we observed a marked decline in the incidence of diabetic nephropathy, from 28% to 9% after 20 years of diabetes, in an unselected population of Type 1 diabetes diagnosed between 1961 and 1980 [8]. However, we could not find a significant decrease of severe, lasertreated retinopathy [9].…”

contrasting

confidence: 63%

“…When the patients were divided into 5-year cohorts according to the time of diagnosis, there was a declining trend in the cumulative proportion of severe retinopathy after 25 to 30 years of diabetes. Furthermore the previously reported marked decrease in the cumulative proportion of diabetic nephropathy persisted [8]. We defined severe retinopathy as laser-treated retinopathy, because it is more definite than just proliferative retinopathy or macular oedema.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Nordwall

Bojestig²,

Arnqvist³

et al. 2004

Diabetologia

187

122

View full text Add to dashboard Cite

Aims/hypothesis. In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to10 years later in the same population. Methods. We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninetyone percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes.Results. The cumulative proportion of severe retinopathy had declined (p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years, it was 32% (20-44) and 11% (2-20) for the oldest cohorts (p<0.0001). Conclusions/interpretation. In an unselected population with Type 1 diabetes diagnosed in childhood, modern diabetes care markedly reduced the incidence of severe retinopathy and nephropathy.

show abstract

contrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Nordwall

Bojestig²,

Arnqvist³

et al. 2004

Diabetologia

187

122

View full text Add to dashboard Cite

show abstract

“…Relationship between glycaemic control at baseline and percentage of subjects progressing to macroalbuminuria at follow-up. *p<0.05 and **p<0.01 vs HbA 1 c ≤5.5% and according to older epidemiological studies [19,20], persistently microalbuminuric patients may be at relatively low risk of progressing to that condition. However, in a recent study [21], the rate of progression to macroalbuminuria in patients with diabetes duration in excess of 30 years was 4.5 per 100 person-years, supporting the notion that even Type 1 diabetic patients with long disease duration may show a significant rate of progression to overt nephropathy.…”

Section: Discussionmentioning

confidence: 97%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

View full text Add to dashboard Cite

Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

show abstract

“…As Kussman et al remarked in 1976, "once the clinical signs of nephropathy have become manifest, the natural course is inexorably progressive to death" [9]. There was, therefore, considerable interest in a study from Sweden that, in 1994, reported a dramatic decline in the incidence of diabetic nephropathy: the 20-year cumulative incidence fell from 28% in patients with onset of type 1 diabetes from 1961-1965 to only 5.8% in patients with onset of diabetes from 1971-1975 [11]. Furthermore, not one patient diagnosed between 1976 and 1980 developed persistent proteinuria [11].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

“…There was, therefore, considerable interest in a study from Sweden that, in 1994, reported a dramatic decline in the incidence of diabetic nephropathy: the 20-year cumulative incidence fell from 28% in patients with onset of type 1 diabetes from 1961-1965 to only 5.8% in patients with onset of diabetes from 1971-1975 [11]. Furthermore, not one patient diagnosed between 1976 and 1980 developed persistent proteinuria [11]. These excellent results were probably due to the work of a dedicated team that achieved glycaemic control equivalent to that seen in an intensively treated group in the DCCT study [12].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Rossing

2005

Diabetologia

View full text Add to dashboard Cite

Diabetic microvascular complications in the kidney and the eye are a major burden for diabetic patients due to increased morbidity and mortality. Furthermore, diabetic nephropathy is the leading cause of end-stage renal disease and diabetic retinopathy is the leading cause of blindness in younger patients, representing a major public health concern. During the past two decades beneficial effects of, in particular, aggressive antihypertensive control and strict glycaemic control have been demonstrated in randomised controlled clinical trials. Technological improvements in diabetes care have made good metabolic control easier to achieve. Has this led to an improved prognosis? In observational studies from dedicated centres, a decrease from 47 to 13% has been reported in the incidence of proliferative diabetic retinopathy after 20-25 years of diabetes, and the incidence of overt diabetic nephropathy after 20 years has decreased from 28 to 5.8%. Even functional and morphological remission of diabetic nephropathy has been reported. Despite this, recent population-based studies have failed to demonstrate a decrease in the incidence of blindness caused by diabetes, and the incidence of end-stage renal disease has progressively increased. This may, in part, be the result of a combination of increasing numbers of diabetic patients and a lag phase between improvement in management and a decline in end-stage complications. It is of concern, however, that the results from specialised centres may not apply to routine diabetes care. It is, therefore, mandatory that the beneficial effects of pharmacological and non-pharmacological interventions demonstrated in clinical trials and recommended by treatment guidelines are translated into clinical practice to ensure a widespread improvement in prognosis.

show abstract

Declining Incidence of Nephropathy in Insulin-Dependent Diabetes Mellitus

Abstract: During the past decade the cumulative incidence of diabetic nephropathy, as manifested by persistent albuminuria, among patients who have had diabetes for 25 years has decreased substantially, probably as a result of improved glycemic control.

Cited by 411 publications

References 21 publications

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Contact Info

Product

Resources

About