Issue 177 Item 14 Young Type 2 Diabetics at High Risk of Early Nephropathy

Even with good metabolic control, young adult patients with diabetes, especially those with type 2, are at high risk for renal involvement during the first decade after diagnosis.

Dr. Maria Svensson, of Ume University Hospital, and colleagues enrolled patients ages 15 to 34 diagnosed with diabetes between 1987 and 1988, at a time when intensive glycemic control was the standard of care, they report in the October issue of Diabetes Care. Of the total 469 subjects, 426 were diagnosed with type 1 diabetes.

During median follow-up of 9 years, 31 (6.6%) developed micro- or microalbuminuria. Median time from diagnosis to renal involvement was 7.9 years and was more frequent among patients with type 2 diabetes than those with type 1, at 16% versus 5.6%, respectively (p = 0.016). Among the seven individuals with macroalbuminiua, four had type one and three had type 2 diabetes.

The time course for occurrence of signs of nephropathy was most rapid for type 2 diabetes, and signs of nephropathy tended to be worse. "This highlights the importance of a correct diabetes classification in this age-group, and since clinical diagnosis is difficult, measurement of islet antibodies may be recommended," Dr. Svensonn’s team writes.

HbA1c values ranged from 5.9 to 11, but half of the patients with renal involvement were in the highest quartile of Hba1c values, which ranged from 8.2 to11.2%. High blood pressure was another risk factor for diabetic nephropathy.

"Screening for microalbuminuria should for practical purposes begin as soon as possible after diabetes diagnosis," they write. Diabetes Care 2003;26:2903-29009.

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