Monday , November 20 2017
Home / Specialties / Nephrology / Prevalence of Diabetic Nephropathy In Pediatric Patients

Prevalence of Diabetic Nephropathy In Pediatric Patients

Marked increase found at age 12.

The object of this study was to estimate the prevalence of diabetes and diabetic nephropathy in a large population of U.S. commercially insured patients aged <18 years from 2002 to 2013.

Using the U.S. MarketScan Commercial Claims and Encounters Database, researchers identified 96,171 pediatric patients with diabetes and 3,161 pediatric patients with diabetic nephropathy during 2002–2013. They also estimated prevalence of pediatric diabetes overall, by diabetes type, age, and sex, and prevalence of pediatric diabetic nephropathy overall, by age, sex, and diabetes type.

The results showed that the annual prevalence of diabetes in the whole pediatric population increased from 1.86 to 2.82 per 1,000 during 2002-2013: 1.48 to 2.32 per 1,000 for type 1 diabetes and 0.38 to 0.67 per 1,000 for type 2 diabetes in 2002-2006 and then 0.56 to 0.49 per 1,000 thereafter. The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only in 2002-2013. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in female than in male youth. There was no difference in prevalence of diabetic nephropathy by diabetes type.

From the results it was concluded that the prevalence of diabetes and diabetic nephropathy increased in the U.S. from 2002 to 2013. The prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years.

Although type 1 diabetes accounts for a majority of childhood and adolescent diabetes, type 2 diabetes is becoming more common with the increasing rate of childhood obesity and it is estimated that up to 45% of all new patients with diabetes in this age group have type 2 diabetes. With the rising prevalence of diabetes in children, a rise in diabetes-related complications, such as nephropathy, is anticipated. Moreover, data suggest that the development of clinical macrovascular complications, neuropathy, and nephropathy may be especially rapid among patients with young-onset type 2 diabetes (age of onset <40 years). However, the natural history of young patients with type 2 diabetes and resulting complications has not been well studied. In the U.S., a large 10-year collaborative research project called SEARCH for Diabetes in Youth is currently ongoing and will probably answer several of these questions when results become available. Although it has been reported that prevalence of diabetes significantly increased from 2001 to 2009 among U.S. youth, current robust data on the frequency of diabetic nephropathy in patients <18 years old are lacking. Population-based data on the frequency of diabetic nephropathy in a U.S. pediatric population will inform clinicians about the need for diagnostic awareness and help develop effective treatments for pediatric patients with diabetes.

The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only during the study period. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in females.

It has been reported that overt diabetic nephropathy and kidney failure caused by either type 1 or type 2 diabetes are uncommon during childhood or adolescence. In this study, the annual prevalence of diabetic nephropathy for all cases ranged from 1.16 to 3.44% in pediatric patients with diabetes and was extremely low in the whole pediatric population (range 2.15 to 9.70 per 100,000), confirming that diabetic nephropathy is a very uncommon condition in youth aged <18 years. We observed that the prevalence of diabetic nephropathy increased in both specific and unspecific cases before 2006, with a leveling off of the specific nephropathy cases after 2005, while the unspecific cases continued to increase. The increased prevalence may be at least partly explained by our assumption that diabetic nephropathy persists once it is diagnosed.

Currently, annual screening for albuminuria is recommended in children with a 5-year duration of type 1 diabetes. It is further recommended that urine albumin-to-creatinine ratio be monitored annually in children and adolescents with type 2 diabetes. Most cases (88.5%) of patients considered to have unspecific nephropathy were patients with proteinuria codes in the absence of any other nephropathy codes. One possible explanation for the continued increase in prevalence of unspecific nephropathy over time is that children who have had diabetes for a long time are more likely to be screened and found to have proteinuria, resulting in an increase in prevalence of unspecific diabetic nephropathy as defined in this study. A possible explanation for the plateau in the prevalence of specific diabetic nephropathy (those most likely to be true or severe cases) after 2005 is that improved management of diabetes over time has resulted in fewer cases of diabetic nephropathy. Incidence of nephropathy has been reported to have declined in patients with type 1 diabetes due to aggressive treatment regimens.

This study provides an estimate of the burden of diabetes and diabetic nephropathy in patients aged <18 years in a U.S.-based commercial claims database. The annual prevalence of diabetes increased over the study period mainly because of increases in type 1 diabetes. The annual prevalence of diabetic nephropathy also increased over the study period, although it is uncommon in pediatric patients with diabetes. The prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years. There was no difference in prevalence of diabetic nephropathy by diabetes type.

Practice Pearls:

  • Nephropathy begins early in the pediatric population.
  • Prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years.
  • Clinical macrovascular  complications, neuropathy, and nephropathy may be especially rapid among patients with young-onset type 2 diabetes (age of onset <40 years).

Researched and prepared by Steve Freed, BPharm, Diabetes Educator, Publisher and reviewed by Dave Joffe, BSPharm, CDE

 

ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014;15(Suppl. 20):4–17;Diabetes Care 2016;39:278-284  I DOI: 10.2337/dcl S-1710