PracticeUpdate Diabetes March 2019

EDITOR’S PICKS 11

Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden Diabetes Care

1977-1984 and 1985-1990, independently of dia- betes duration. CONCLUSIONS The risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time. Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: A 38-Year Prospective Nationwide Study. Diabetes Care 2019 Jan 01;42(1)27-31, C Toppe, A Möllsten, I Waernbaum, et al. www.practiceupdate.com/c/77730 Dr. Dahl is Director of the Nephrology Clinical Trials Program, and Associate Professor of Medicine in the Section of Nephrology at Yale University School of Medicine in New Haven, Connecticut. COMMENT By Neera K. Dahl MD, PhD T he present study continues to define the changing epidemi- ology of ESRD due to diabetic nephropathy in young patients with type 1 diabetes. The incidence of type 1 diabetes mellitus is high in Scandina- via, and the long-term ability to track patients is excellent. The study popu- lation is comprised of three datasets, including the Swedish Childhood Dia- betes Register (SCDR) started in 1977, the Diabetes Incidence Study in Swe- den (DISS) started in 1983, and the National Diabetes Register, started in 1996, comprising almost 19,000 unique patients. Cases of ESRD were identified using the Swedish Renal Registry (SRR). The risk of ESRD was lower in patients with diabetes onset in 1991–2001 compared with either 1977–1984 or 1985–1990. Patients with diabetes onset before the age of 10 had a lower risk of ESRD than those diagnosed at an older age. Patients with ESRD had a 12-fold higher risk of death compared with patients without ESRD. This study supports the consensus that improved diabetes care has reduced the risk of ESRD. It also points to the need to con- sider patients with type 1 diabetes and ESRD as an extremely vulnerable pop- ulation.

Take-home message • The authors of this study sought to determine the incidence rate of end-stage renal disease (ESRD) among Swedish patients with type 1 diabetes (T1D). Among participants who had diabetes onset between birth and 34 years of age, and longer than 14 years since disease onset, the incidence was 5.6%. The most recent cohort (onset between 1991 and 2001) had a lower incidence than earlier cohorts (1977–1990). • The results indicate that the incidence of ESRD in individuals with T1D is low in Sweden and may be declining in more recent years.

Abstract OBJECTIVE Diabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden. RESEARCH DESIGN AND METHODS In this study, patients with duration of type 1 diabetes >14 years and age at onset of diabetes 0-34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Swe- den, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD.

" It also points to the need to consider patients with type 1 diabetes and ESRD as an extremely vulnerable population. "

RESULTS We found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabe- tes onset in 1991-2001 compared to onset in

VOL. 3 • NO. 1 • 2019