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Young Type 2 Diabetics More Likely to Suffer Kidney Failure

Study of Native American tribe may have prevention message for all, researchers say

TUESDAY, July 25, 2006 (HealthDay News) -- Getting a diagnosis of type 2 diabetes before your 20th birthday seriously increases your risk of kidney failure and death, a new study suggests.

The study, which included 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 earlier 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," said study researcher Dr. Robert G. Nelson, a staff clinician for 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."

More than 100,000 Americans are diagnosed with kidney failure or end-stage renal disease 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, blacks and Hispanics with diabetes have higher rates of kidney failure from the disease, the institute noted.

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 the disease before they were 20 years old.

Overall, those diagnosed in their youth had about a fivefold increase in the incidence of end-stage renal disease in middle age, compared to those diagnosed at an older age. Specifically, the youth-onset group was 8.4 times more likely to have end-stage renal disease between 25 and 34 than those diagnosed after 20. The youth-onset group was also five times more likely to have end-stage renal disease 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 as well. 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 occurred in the group diagnosed after age 20.

Nelson said the study authors believe the primary reason for the increase in end-stage renal disease and mortality is simply that the youth-onset group had diabetes for a longer period of time.

The results are published in the July 26 issue of the Journal of the American Medical Association.

Dr. Stuart Weiss, an endocrinologist at New York University Medical School in New York City, said, "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., said he thinks 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," Tolia said. "This is where lifestyle modifications come in. Maintain your ideal body weight and exercise."

Nelson added, "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. This sounds simple enough, but it can be hard to do. Newer medicines make it easier to do than in the past," Nelson said.

In type 2 diabetes, the body doesn't 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 information

To learn more about kidney disease and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Robert G. Nelson, M.D., Ph.D., staff clinician, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix; Kirit Tolia, M.D., medical director, Joslin Diabetes Center at Providence Hospital, Southfield, Mich.; Stuart Weiss, M.D., endocrinologist, New York University Medical Center, and clinical assistant professor, New York University School of Medicine, New York City; July 26, 2006, Journal of the American Medical Association
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