Diabetes Care：青年2型糖尿病患者肾脏不良转归危险升高

High Burden of Kidney Disease in Youth-Onset Type 2 Diabetes

Allison B. Dart, Elizabeth A. Sellers, Patricia J. Martens, Claudio Rigatto, Marni D. Brownell, and Heather J. Dean

Abstract： OBJECTIVETo evaluate renal outcomes and survival in youth with type 2 diabetes versus type 1 diabetes versus nondiabetic control subjects.RESEARCH DESIGN AND METHODSIn total, 342 prevalent youth (aged 1-18 years) with type 2 diabetes, 1,011 youth with type 1 diabetes, and 1,710 control subjects iden... OBJECTIVETo evaluate renal outcomes and survival in youth with type 2 diabetes versus type 1 diabetes versus nondiabetic control subjects.RESEARCH DESIGN AND METHODSIn total, 342 prevalent youth (aged 1-18 years) with type 2 diabetes, 1,011 youth with type 1 diabetes, and 1,710 control subjects identified from 1986 to 2007 were anonymously linked to health care records housed at the Manitoba Centre for Health Policy to assess long-term outcomes using ICD codes.RESULTSYouth with type 2 diabetes were found to have a fourfold increased risk of renal failure versus youth with type 1 diabetes. Risk factors associated with renal failure were renin angiotensin aldosterone system inhibitor use and albuminuria in adolescence. Compared with control subjects (age, sex, and postal code matched), youth with type 2 diabetes had a 23-fold increased risk of renal failure and a 39-fold increased risk of dialysis. Kaplan-Meier survival at 10 years was 91.4% in the type 2 diabetic group versus 99.5% in the type 1 diabetic group (P < 0.0001). Renal survival was 100% at 10 years in both groups. It decreased to 92.0% at 15 years and 55.0% at 20 years in the type 2 diabetic group but remained stable in the type 1 diabetic group (P < 0.0001).CONCLUSIONSYouth with type 2 diabetes are at high risk of adverse renal outcomes and death. Albuminuria and angiotensin aldosterone system inhibitor use, which may be a marker of severity of disease, are associated with poor outcomes in early adulthood.