Diabetic nephropathy in type 1 (insulin-dependent) diabetes: An epidemiological study

Abstract

A follow-up of 1475 Type 1 (insulin-dependent) diabetic patients diagnosed before 1953 (815 males, 660 females) and before the age of 31 years was conducted. All patients were seen at the Steno Memorial Hospital and were referred from all parts of Denmark; 91 (6%) could not be traced. The rest (94%) were followed until death or for at least 25 years; 249 (17%) were followed for greater than 40 years. Clinical diabetic nephropathy developed in 531 (41%) of the 1303 patients in whom sufficient information was available regarding proteinuria. Other causes of proteinuria were found in 3%, and 57% did not develop persistent proteinuria. The prevalence of diabetic nephropathy was 21% after 20-25 years of diabetes duration followed by a decline to 10% after 40 years. Two incidence peaks of the onset of proteinuria were seen, one after 16 and another after 32 years duration of diabetes and was low after 35 years duration. The cumulative incidence was 45% after 40 years of diabetes. A male preponderance was seen among patients with nephropathy. A significant difference in the pattern of annual incidence rates of diabetic nephropathy was seen, when groups with onset of diabetes before 1933, between 1933-1942, and 1943-1952, respectively, were compared. An association between daily insulin requirement and nephropathy incidence was found. Patients with nephropathy had a much poorer survival than those without proteinuria; 40 years after onset of diabetes, only 10% of patients who developed nephropathy were alive, whereas greater than 70% of patients who did not develop nephropathy survived.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Some patients died before developing complications, but it is unlikely that this has influenced the results. The mortality was high in the oldest cohort (diagnosis between 1961and 1965) due to nephropathy as was also found in other studies [15,32]. In the younger cohorts mortality was lower than expected [33].…”

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

“…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.…”

Juxtaglomerular apparatus T-cell infiltration affects glomerular structure in Type 1 diabetic patients

“…Keywords Diabetic nephropathy · Type 1 diabetes · juxtaglomerular apparatus · T-cell Only a subset of Type 1 insulin-dependent diabetic patients develop overt diabetic nephropathy [1]. It is well known that hyperglycaemia is a major risk factor for diabetic nephropathy but hyperglycaemia does not account for all changes observed [2].…”