Early Type 1 Diabetes Onset Is Protective Against End-Stage Renal Disease

Earlier diabetes onset may prolong the time to ESRD. The development of end-stage renal disease (ESRD) due to diabetic nephropathy occurs in less than 1% of patients with childhood-onset type 1 diabetes, according to investigators in Sweden, who suggest that an earlier diabetes onset may prolong the time to ESRD.

In a population-based study, published in the March issue of Diabetes Care, researchers used data from two nationwide registers, which include 12,032 cases of childhood onset of type 1 diabetes, to examine the cumulative incidence of ESRD due to diabetic nephropathy. The median duration of diabetes was 21 years.

After a maximum follow-up of 27 years, Dr. Maria Svensson, of Umea University Hospital, and colleagues found that 33 (0.7%) patients developed ESRD due to diabetic nephropathy and all of these patients had a diabetes duration of more than 15 years.

"A significant difference in risk of developing ESRD was found between the youngest (0 to 4 years) and the two older (5 to 9 and 10 to 14 years) age-at-onset strata (p = 0.03 and p = 0.001, respectively)," Dr. Svensson and colleagues report. "No patients with onset of diabetes before 5 years of age had developed ESRD."

The researchers note that the mechanism behind the effect of age at onset is unclear. It has been suggested that puberty, characterized by rapid growth, hormonal changes, and worsening in glycemic control, may accelerate the processes that lead to chronic diabetes complications.
Diabetes Care 2006;29:538-542.

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DID YOU KNOW:
Intake of whole grains is inversely associated with the risk of diabetes and ischemic heart disease: The lower risk associated with high whole-grain intakes may be mediated through improvements in glycemic control, lipid profiles, or reduced inflammation. The objective of this study was to examine whether the intake of whole grains, bran, and germ is related to homocysteine, plasma markers of glycemic control (fasting insulin, hemoglobin A1c, C-peptide, and leptin), lipids (total cholesterol, triacylglycerol, HDL cholesterol, and LDL cholesterol), and inflammation (C-reactive protein, fibrinogen, and interleukin. They concluded: “The results suggest a lower risk of diabetes and heart disease in persons who consume diets high in whole grains.”
American Journal of Clinical Nutrition, Vol. 83, No. 2, 275-283, February 2006

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