Young adult onset type 2 diabetes versus type 1 diabetes: Progression to and survival on renal replacement therapy
Development of diabetic complications, including nephropathy early in the disease course, is common with young-onset type 2 diabetes. However, there are limited data to compare its progression to end-stage kidney disease (ESKD) requiring renal replacement therapy or renal-related death (RRT/RRD). Timothy L Middleton and colleagues conducted research under the title “Young adult-onset type 2 diabetes versus type 1 diabetes: Progression to and survival on renal replacement therapy” published in the Journal of Diabetes and its Complications. The summary of this research can be studied below:
Objective:
To investigate the progression of young-onset type 2 diabetes and type 1 diabetes to end-stage kidney disease (ESKD) and survival on renal replacement therapy.
Method:
The concerned data was collected from the RPAH Diabetes Centre, Australian and New Zealand Dialysis and Transplant Registry, and National Death Index. Young-onset type 1 and type 2 diabetes between the age of 15-35 years were included. The progression to ESKDwas determined with the help of Cox Proportional Hazards Modelling approaches and Cumulative Incidence Competing Risk.
Findings:
The results indicate that progression to ESKD in YT2DM is greater as compare to YT1DM and this difference can be attributable to differences in BMI. However, after the initiation of ESKD, both YT2DM and YT1DM do equally poorly. While appropriate management studies are not yet clear, investigators encourage proactive risk factor management in young adults with diabetes. Cardiovascular outcome trials showed favorable results for SGLT2 inhibitors, suggesting it as an emerging class of medications as reno-protective agents. However, these findings should be supported by future researches. Additionally, while RAAS blockade has been found to possess a reno-protective effect in adults, there is a lack of strong evidence supporting ACE inhibition or angiotensin II receptor blockade in youth with diabetes.
Future researches should determine appropriate glycemic and blood pressure targets for youth, along with evidence-based management strategies for the YT2DM.
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