Issue 175 Item 8 Can Signs of Nephropathy Occur Early in Young Adults With Diabe

Will young adult patients with diabetes still develop renal involvement during the first 10 years of diabetes duration, even with good control, the question answered from The Diabetes Incidence Study in Sweden.

The objective was to estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure.

aims to register all incident cases of diabetes in the age-group 15–34 years. In 1987–1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186).

During the follow-up time, median 9 years (range 6–12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA1c during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure.

It was concluded that despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA1c, high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy. Diabetes Care 26:2903-2909, 2003

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FACT: Omega-3 Level Could Be Predictive of CHD Death
The Omega-3 Index could serve as a simple, independent, and clinically modifiable marker for the risk of death from coronary heart disease.Ppatients with an Omega-3 Index below the cardioprotective level of 8% could easily and inexpensively improve their risk profile by eating more fatty fish or taking fish oil supplements, said Dr. Harris, codirector of the lipid and diabetes research center at the Mid America Heart Institute, St. Luke’s Hospital, Kansas City, Mo. in the landmark GISSI-Prevenzione trial, supplements of n-3 fatty acids totaling 850 mg/day in more than 5,600 post-MI patients were associated with an approximate 29% reduction in CHD death at 3.5 years (Lancet 354[9177]:447-55, 1999)