Young
People with Type 2 Diabetes More Likely to Have Kidney Failure
Receiving a diagnosis of type 2 diabetes before a person
turns 20 years of age seriously increases the risk of kidney failure and death,
according to a report in the Journal of the American
Medical Association (JAMA).
The study, which includes nearly 40 years of information
from a Southwestern Indian tribe, found that the rate of serious kidney disease
occurring before the age of 35 was more than eight times higher in people diagnosed
with type 2 diabetes before they were 20, compared with those who were diagnosed
between 20 and 55 years of age.
Additionally, the study found that people diagnosed with
type 2 diabetes early in life had a death rate between the ages of 25 and 55
that was twice as high as that of people diagnosed later in life.
"The frequency of ESRD [end-stage renal disease] is nearly
fivefold higher during mid-life among those diagnosed with diabetes in youth," says
study researcher Dr. Robert G. Nelson, at the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
"This observation has profound implications not only for
this population, but for others since type 2 diabetes is being diagnosed with
increasing frequency among children and adolescents in many different populations.
Diabetes in youth is not something to be taken lightly."
In type 2 diabetes, the body does not produce enough of
the hormone insulin or the cells ignore the insulin. Insulin is necessary for
the body to metabolize sugar for energy.
Besides kidney disease, complications from type 2 diabetes
include heart disease, blindness, and nerve damage, according to the American
Diabetes Association.
More than 100,000 Americans are diagnosed with kidney failure
or ESRD every year, according to the NIDDK.
About 45 percent of those cases are caused by diabetes.
For people with kidney failure, two treatment options exist - dialysis or kidney
transplant.
Fortunately, not everyone who has diabetes will develop
kidney failure. However, Native Americans, African Americans, and Hispanics
with diabetes have higher rates of kidney failure from the disease, state experts.
Beginning in 1965, members of a Southwestern Native American
tribe were asked to participate in a long-term study of type 2 diabetes and
its complications.
Every two years, whether they were healthy or ill, the study
participants underwent a thorough health exam, including blood glucose measurements.
More than 1,800 people with diabetes participated in the
study and results through 2002 were included in the current analysis. Ninety-six
people were diagnosed with ESRD before they were 20 years old.
Overall, those diagnosed in their youth had about a fivefold
increase in the incidence of ESRD in middle age, compared to those diagnosed
at an older age.
Specifically, the youth-onset group was 8.4 times more likely
to have ESRD between 25 and 34 than those diagnosed after 20.
The youth-onset group was also five times more likely to
have ESRD between 35 and 44, and four times more likely to have the condition
between the ages of 45 and 54 than those diagnosed at an older age.
In addition, the death rate was significantly higher for
the early-onset group.
Between the ages of 25 and 55, 15.4 deaths per 1,000 person
years occurred in the youth-onset group, while only 7.3 deaths per 1,000 person
years occurred in the group diagnosed after age 20.
Dr. Nelson says the study authors believe the primary reason
for the increase in ESRD and mortality is simply that the youth-onset group
had diabetes for a longer period of time.
Dr. Stuart Weiss, an endocrinologist at New York University
Medical School, says, "Given the fact that there is more and more and younger
and younger type 2 diabetes, this study should send up a little bit of an alarm.
But I don't know that we can say for sure this is what will happen in every
population."
Dr. Kirit Tolia, medical director of the Joslin Diabetes
Center at Providence Hospital in Southfield, Mich., says he believes the findings
would be similar in other groups of people, and points to the need to prevent
or at least delay the onset of diabetes.
"Prevention of early diabetes, that's the key," Dr. Tolia
says. "This is where lifestyle modifications come in. Maintain your ideal body
weight and exercise."
Dr. Nelson adds, "Modest exercise, performed routinely,
can substantially lower the risk of diabetes."
If you already have diabetes, all three experts said that
maintaining tight control of your blood pressure and blood sugar is extremely
important for preventing complications.
"Control of blood pressure and blood sugar is the best way
to reduce the risk of diabetic complications,” notes Dr. Nelson. “This
sounds simple enough, but it can be hard to do. Newer medicines make it easier
to do than in the past.”
Always consult your physician for more information. |
