Kidney Failure Risk in Type 1 vs. Type 2 childhood-onset Diabetes Mellitus
Type 2 diabetes mellitus (T2DM) and its long-term complications, such as diabetic kidney disease (DKD) are becoming more common in children and adolescents. Presently, there are short of research data to direct towards long-term renal outcome and risk of mortality in T2DM with respect to the general population. Hence, Oren Pleniceanu and colleagues conducted a reasearch under title “Kidney failure risk in type 1 vs. type 2 childhood-onset diabetes mellitus” published in the journal of pediatric neurology. The summary of this study is given below:
Objective:
To compare the risk of future end-stage kidney disease (ESKD) and all-cause mortality in the pediatric population with the onset of T1DM, the onset of T2DM, and a cohort with no history of childhood diabetes.
Methods:
This is a nationwide, retrospective, population-based cohort study,conducted with 1,500,522 adolescents. Subjects were examined for military service between 1967 and 1997, which were stratified according to the presence and type of diabetes. Data were registered in the Israeli ESKD registry. In order to estimate the hazard ratio (HR) for ESKD, Cox proportional-hazards models were used.
Findings:
Study concludes that adolescent with T1DM and T2DM with normal renal function possess a significantly increased risk for ESKD. Additionally, T1DM was found to be associated with younger age at ESKD onset whereas T2DM is associated with higher mortality rate. This directs that, risk is mostly contributable because of longer disease duration in T1DM compared with T2DM. Lastly, investigators indicate that progression of disease from early CKD to ESKD is significantly lower in T2DM.
Limitation:
Firstly, data on DM and data on treated ESKD were collected from on different period, 1967 and 1980 respectively. Secondly, clinical information, such as normal creatinine levels and diagnosis of DM were not measure but reported. They are a lack of follow-up data. Thirdly, the exact period of DM diagnosis in childhood is missing. Additionally, the study was conducted on jewish recruits and hence cannot be generalized. Lastly, there is possibility that the risk of ESKD and mortality is affected by the introduction of the newer anti-diabetic medications.
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