FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 330:15-18 January 6, 1994 Number 1 Next

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background The high relative mortality among patients with insulin-dependent diabetes mellitus results mainly from diabetic nephropathy. The cumulative incidence of nephropathy of 25 to 30 percent among patients who had had diabetes for 25 years remained stable from 1950 to the early 1980s. In a population study, we assessed recent trends in the incidence of diabetic nephropathy.

Methods We studied all 213 patients in whom insulin-dependent diabetes mellitus was diagnosed before the age of 15 years between 1961 and 1980 in a district in southeastern Sweden. Ninety-two percent of the patients were followed from the onset of diabetes to 1991 or to death. Patients with persistent albuminuria (positive Albustix test) were considered to have diabetic nephropathy. Glycosylated hemoglobin was measured periodically in all patients, beginning in 1980.

Results The cumulative incidence of persistent albuminuria after 25 years of diabetes decreased from 30.0 percent among the patients in whom diabetes developed in the period 1961 to 1965 to 8.9 percent among those in whom it developed from 1966 to 1970 (P = 0.01). After 20 years of diabetes, the cumulative incidence decreased from 28.0 percent among the patients in whom diabetes developed from 1961 to 1965 to 5.8 percent among those in whom it developed from 1971 to 1975 (P = 0.01). Persistent albuminuria has not yet developed in any patient in whom diabetes was diagnosed in the period 1976 to 1980. The average glycosylated hemoglobin value decreased from 7.4 percent in the period 1980 to 1985 to 7.0 percent from 1986 to 1991 (P<0.001). The mean glycosylated hemoglobin value was higher in the patients with persistent albuminuria than the patients with no albuminuria (8.1 percent vs. 7.1 percent, P<0.001).

Conclusions During the past decade the cumulative incidence of diabetic nephropathy, as manifested by persistent albuminuria, among patients who have had diabetes for 25 years has decreased substantially, probably as a result of improved glycemic control.

Source Information

From the Departments of Internal Medicine (M.B., H.J.A., B.E.K.) and Pediatrics (G.H., J.L.), University Hospital, Linkoping, Sweden, and the Department of Internal Medicine, Eksjo Hospital, Eksjo, Sweden (M.B.).

Address reprint requests to Dr. Bojestig at the Department of Medicine, Eksjo Hospital, S-575 81 Eksjo, Sweden.

Full Text of this Article

This article has been cited by other articles:

• Wong, T. Y., Mwamburi, M., Klein, R., Larsen, M., Flynn, H., Hernandez-Medina, M., Ranganathan, G., Wirostko, B., Pleil, A., Mitchell, P. (2009). Rates of Progression in Diabetic Retinopathy During Different Time Periods: A systematic review and meta-analysis. Diabetes Care 32: 2307-2313 [Abstract] [Full Text]  
• Greene, S. (2009). Diabetes in the young: what are their long term health prospects?. Arch. Dis. Child. 94: 251-253 [Full Text]  
• Nakhoul, F. M., Miller-Lotan, R., Awad, H., Asleh, R., Jad, K., Nakhoul, N., Asaf, R., Abu-Saleh, N., Levy, A. P. (2009). Pharmacogenomic effect of vitamin E on kidney structure and function in transgenic mice with the haptoglobin 2-2 genotype and diabetes mellitus. Am. J. Physiol. Renal Physiol. 296: F830-F838 [Abstract] [Full Text]  
• Amin, R, Widmer, B, Dalton, R N, Dunger, D B (2009). Unchanged incidence of microalbuminuria in children with type 1 diabetes since 1986: a UK based inception cohort. Arch. Dis. Child. 94: 258-262 [Abstract] [Full Text]  
• Rathcke, C. N., Persson, F., Tarnow, L., Rossing, P., Vestergaard, H. (2009). YKL-40, a Marker of Inflammation and Endothelial Dysfunction, Is Elevated in Patients With Type 1 Diabetes and Increases With Levels of Albuminuria. Diabetes Care 32: 323-328 [Abstract] [Full Text]  
• Deshpande, A. D, Harris-Hayes, M., Schootman, M. (2008). Epidemiology of Diabetes and Diabetes-Related Complications. ptjournal 88: 1254-1264 [Abstract] [Full Text]  
• Ludvigsson, J., Faresjo, M., Hjorth, M., Axelsson, S., Cheramy, M., Pihl, M., Vaarala, O., Forsander, G., Ivarsson, S., Johansson, C., Lindh, A., Nilsson, N.-O., Aman, J., Ortqvist, E., Zerhouni, P., Casas, R. (2008). GAD Treatment and Insulin Secretion in Recent-Onset Type 1 Diabetes. NEJM 359: 1909-1920 [Abstract] [Full Text]  
• Yuzawa, Y., Niki, I., Kosugi, T., Maruyama, S., Yoshida, F., Takeda, M., Tagawa, Y., Kaneko, Y., Kimura, T., Kato, N., Yamamoto, J., Sato, W., Nakagawa, T., Matsuo, S. (2008). Overexpression of Calmodulin in Pancreatic {beta} Cells Induces Diabetic Nephropathy. J. Am. Soc. Nephrol. 19: 1701-1711 [Abstract] [Full Text]  
• Rossing, P., Parving, H.-H., de Zeeuw, D. (2006). Renoprotection by blocking the RAAS in diabetic nephropathy--fact or fiction?. Nephrol Dial Transplant 21: 2354-2357 [Full Text]  
• Myint, K.-M., Yamamoto, Y., Doi, T., Kato, I., Harashima, A., Yonekura, H., Watanabe, T., Shinohara, H., Takeuchi, M., Tsuneyama, K., Hashimoto, N., Asano, M., Takasawa, S., Okamoto, H., Yamamoto, H. (2006). RAGE Control of Diabetic Nephropathy in a Mouse Model: Effects of RAGE Gene Disruption and Administration of Low-Molecular Weight Heparin. Diabetes 55: 2510-2522 [Abstract] [Full Text]  
• McClellan, W. M. (2006). The epidemic of renal disease--what drives it and what can be done?. Nephrol Dial Transplant 21: 1461-1464 [Full Text]  
• Pambianco, G., Costacou, T., Ellis, D., Becker, D. J., Klein, R., Orchard, T. J. (2006). The 30-year natural history of type 1 diabetes complications: the pittsburgh epidemiology of diabetes complications study experience.. Diabetes 55: 1463-1469 [Abstract] [Full Text]  
• Svensson, M., Nystrom, L., Schon, S., Dahlquist, G., on behalf of the Swedish Childhood Diabetes Study, (2006). Age at Onset of Childhood-Onset Type 1 Diabetes and the Development of End-Stage Renal Disease: A nationwide population-based study.. Diabetes Care 29: 538-542 [Abstract] [Full Text]  
• Kosugi, T., Yuzawa, Y., Sato, W., Kawai, H., Matsuo, S., Takei, Y., Muramatsu, T., Kadomatsu, K. (2006). Growth Factor Midkine Is Involved in the Pathogenesis of Diabetic Nephropathy. Am. J. Pathol. 168: 9-19 [Abstract] [Full Text]  
• Finne, P., Reunanen, A., Stenman, S., Groop, P.-H., Gronhagen-Riska, C. (2005). Incidence of End-stage Renal Disease in Patients With Type 1 Diabetes. JAMA 294: 1782-1787 [Abstract] [Full Text]  
• Mohsin, F., Craig, M. E, Cusumano, J., Chan, A. K.F., Hing, S., Lee, J. W., Silink, M., Howard, N. J., Donaghue, K. C. (2005). Discordant Trends in Microvascular Complications in Adolescents With Type 1 Diabetes From 1990 to 2002. Diabetes Care 28: 1974-1980 [Abstract] [Full Text]  
• Inada, A., Nagai, K., Arai, H., Miyazaki, J.-i., Nomura, K., Kanamori, H., Toyokuni, S., Yamada, Y., Bonner-Weir, S., Weir, G. C., Fukatsu, A., Seino, Y. (2005). Establishment of a Diabetic Mouse Model with Progressive Diabetic Nephropathy. Am. J. Pathol. 167: 327-336 [Abstract] [Full Text]  
• Marshall, S M (2004). Recent advances in diabetic nephropathy. Postgrad. Med. J. 80: 624-633 [Abstract] [Full Text]  
• Ohashi, S., Abe, H., Takahashi, T., Yamamoto, Y., Takeuchi, M., Arai, H., Nagata, K., Kita, T., Okamoto, H., Yamamoto, H., Doi, T. (2004). Advanced Glycation End Products Increase Collagen-specific Chaperone Protein in Mouse Diabetic Nephropathy. J. Biol. Chem. 279: 19816-19823 [Abstract] [Full Text]  
• Svensson, M., Eriksson, J. W., Dahlquist, G. (2004). Early Glycemic Control, Age at Onset, and Development of Microvascular Complications in Childhood-Onset Type 1 Diabetes: A population-based study in northern Sweden. Diabetes Care 27: 955-962 [Abstract] [Full Text]  
• Fagerudd, J., Forsblom, C., Pettersson-Fernholm, K., Groop, P.-H. (2004). Implementation of Guidelines for the Prevention of Diabetic Nephropathy. Diabetes Care 27: 803-804 [Full Text]  
• Torbjornsdotter, T. B., Jaremko, G. A., Berg, U. B. (2004). Nondipping and Its Relation to Glomerulopathy and Hyperfiltration in Adolescents With Type 1 Diabetes. Diabetes Care 27: 510-516 [Abstract] [Full Text]  
• Torrance, T, Franklin, V, Greene, S (2003). Insulin pumps. Arch. Dis. Child. 88: 949-953 [Full Text]  
• Svensson, M., Sundkvist, G., Arnqvist, H. J., Bjork, E., Blohme, G., Bolinder, J., Henricsson, M., Nystrom, L., Torffvit, O., Waernbaum, I., Ostman, J., Eriksson, J. W. (2003). Signs of Nephropathy May Occur Early in Young Adults With Diabetes Despite Modern Diabetes Management: Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS). Diabetes Care 26: 2903-2909 [Abstract] [Full Text]  
• Arun, C. S., Stoddart, J., Mackin, P., MacLeod, J. M., New, J. P., Marshall, S. M. (2003). Significance of Microalbuminuria in Long-Duration Type 1 Diabetes. Diabetes Care 26: 2144-2149 [Abstract] [Full Text]  
• Nagai, K., Arai, H., Yanagita, M., Matsubara, T., Kanamori, H., Nakano, T., Iehara, N., Fukatsu, A., Kita, T., Doi, T. (2003). Growth Arrest-specific Gene 6 Is Involved in Glomerular Hypertrophy in the Early Stage of Diabetic Nephropathy. J. Biol. Chem. 278: 18229-18234 [Abstract] [Full Text]  
• Ludvigsson, J., Hanas, R. (2003). Continuous Subcutaneous Glucose Monitoring Improved Metabolic Control in Pediatric Patients With Type 1 Diabetes: A Controlled Crossover Study. Pediatrics 111: 933-938 [Abstract] [Full Text]  
• Hovind, P., Tarnow, L., Rossing, K., Rossing, P., Eising, S., Larsen, N., Binder, C., Parving, H.-H. (2003). Decreasing Incidence of Severe Diabetic Microangiopathy in Type 1 Diabetes. Diabetes Care 26: 1258-1264 [Abstract] [Full Text]  
• Nordfeldt, S., Samuelsson, U. (2003). Serum ACE Predicts Severe Hypoglycemia in Children and Adolescents With Type 1 Diabetes. Diabetes Care 26: 274-278 [Abstract] [Full Text]  
• Betts, P R, Swift, P G F (2003). Doctor, who will be looking after my child's diabetes?. Arch. Dis. Child. 88: 6-7 [Full Text]  
• Nathan, D. M. (2002). The Impact of Clinical Trials on the Treatment of Diabetes Mellitus. J. Clin. Endocrinol. Metab. 87: 1929-1937 [Abstract] [Full Text]  
• Rossing, P., Hougaard, P., Parving, H.-H. (2002). Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients: A 10-year prospective observational study. Diabetes Care 25: 859-864 [Abstract] [Full Text]  
• Dahlquist, G., Stattin, E.-L., Rudberg, S. (2001). Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long-term follow-up study of childhood onset type-1 diabetic patients. Nephrol Dial Transplant 16: 1382-1386 [Abstract] [Full Text]  
• Reach, G. (2001). Islet transplantation: a field on the move. Nephrol Dial Transplant 16: 893-896 [Full Text]  
• Möllsten, A. V., Dahlquist, G. G., Stattin, E.-L., Rudberg, S. (2001). Higher Intakes of Fish Protein Are Related to a Lower Risk of Microalbuminuria in Young Swedish Type 1 Diabetic Patients. Diabetes Care 24: 805-810 [Abstract] [Full Text]  
• Mlacak, B, Jaksic, Z, Vuletic, S (1999). Albuminuria, cardiovascular morbidity and mortality in diabetic and non-diabetic subjects in a rural general practice. Fam Pract 16: 580-585 [Abstract] [Full Text]  
• The Diabetes Control and Complications Trial Resea, (1996). Lifetime Benefits and Costs of Intensive Therapy as Practiced in the Diabetes Control and Complications Trial. JAMA 276: 1409-1415 [Abstract]  
• Kiberd, B. A, Jindal, K. K (1995). Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation. BMJ 311: 1595-1599 [Abstract] [Full Text]  
• Clark, C. M., Lee, D. A. (1995). Prevention and Treatment of the Complications of Diabetes Mellitus. NEJM 332: 1210-1217 [Full Text]  
• (1994). IS CHANGING DIABETES CARE PREVENTING NEPHROPATHY?. JWatch General 1994: 6-6 [Full Text]