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Cumulative risk, age at onset, and sex-specific differences for developing end-stage renal disease in young patients with type 1 diabetes: A nationwide population-based cohort study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Umeå University, Faculty of Social Sciences, Department of Statistics.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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2010 (English)In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 59, no 7, 1803-1808 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE—This study aimed to estimate the current cumulativerisk of end-stage renal disease (ESRD) due to diabeticnephropathy in a large, nationwide, population-based prospectivetype 1 diabetes cohort and specifically study the effects ofsex and age at onset.RESEARCH DESIGN AND METHODS—In Sweden, all incidentcases of type 1 diabetes aged 0–14 years and 15–34 years arerecorded in validated research registers since 1977 and 1983,respectively. These registers were linked to the Swedish RenalRegistry, which, since 1991, collects data on patients who receiveactive uremia treatment. Patients with 13 years duration of type1 diabetes were included (n 11,681).RESULTS—During a median time of follow-up of 20 years, 127patients had developed ESRD due to diabetic nephropathy. Thecumulative incidence at 30 years of type 1 diabetes duration waslow, with a male predominance (4.1% [95% CI 3.1–5.3] vs. 2.5%[1.7–3.5]). In both male and female subjects, onset of type 1diabetes before 10 years of age was associated with the lowestrisk of developing ESRD. The highest risk of ESRD was found inmale subjects diagnosed at age 20–34 years (hazard ratio 3.0 [95%CI 1.5–5.7]). In female subjects with onset at age 20–34 years, therisk was similar to patients’ diagnosed before age 10 years.CONCLUSIONS—The cumulative incidence of ESRD is exceptionallylow in young type 1 diabetic patients in Sweden. There isa striking difference in risk for male compared with femalepatients. The different patterns of risk by age at onset and sexsuggest a role for puberty and sex hormones.

Place, publisher, year, edition, pages
American Diabetes Association , 2010. Vol. 59, no 7, 1803-1808 p.
Keyword [en]
diabetes, end stage renal disease
National Category
Urology and Nephrology
Research subject
URN: urn:nbn:se:umu:diva-35198DOI: 10.2337/db09-1744ISI: 000279615100031OAI: diva2:337770
Available from: 2010-08-09 Created: 2010-08-09 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Epidemiological studies of childhood diabetes and important health complications to the disease
Open this publication in new window or tab >>Epidemiological studies of childhood diabetes and important health complications to the disease
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D.

Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD.

Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age.

Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 45 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1625
Type- 1 diabetes, type-2 diabetes, end stage renal disease, mortality, socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes Pediatrics
Research subject
urn:nbn:se:umu:diva-85248 (URN)978-91-7459-804-9 (ISBN)
Public defence
2014-02-21, Stora Aulan, Sunderby sjukhus, Sunderby sjukhus, Luleå, 13:00 (Swedish)
Available from: 2014-01-31 Created: 2014-01-31 Last updated: 2014-01-31Bibliographically approved

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Möllsten, AnnaWaernbaum, IngeborgBerhan, YonasNyström, LennarthDahlquist, Gisela
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