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J Clin Endocrinol Metab. 2014 Dec;99(12):4523-30. doi: 10.1210/jc.2014-2701.

Mortality and incidence of renal replacement therapy in people with type 1 diabetes mellitus--a three decade long prospective observational study in the Lainz T1DM cohort.

Author information

1
Third Medical Department (M.S., M.A., R.P.), Hietzing Hospital Vienna Wolkersbergenstr. 1, 1130 Vienna, Austria; Diabetes Research Group (M.S., S.A.A.), King's College London, 10, Cutcombe Road, SE5 9RJ London, United Kingdom; Karl-Landsteiner Institute of Metabolic Diseases and Nephrology (S.P., H.S-K., T.K., R.P.), Hietzing Hospital Vienna, Wolkersbergenstr. 1, 1130 Vienna, Austria; Former Ludwig Boltzmann Institute for Metabolic Diseases and Diabetes (K.I.), 1130 Vienna, Austria; Austrian Dialysis and Transplantation Registry (R.K.), Klinikum Kreuzschwestern, Grieskirchner Strasse 42, 4600 Wels, Austria; Department of Ophthalmology (A.R.), Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; Department of Medical Genetics (F.K.), Division of Genetic Epidemiology, Innsbruck Medical University, Schöpfst. 41, 6020 Innsbruck Austria.

Abstract

CONTEXT AND OBJECTIVE:

We investigated long term mortality, requirement for renal replacement therapy (RRT), and incidence of other late diabetic complications in an observational cohort study of 641 people with type 1 diabetes (T1DM).

DESIGN:

Prospective observational cohort study.

SETTING:

The study was conducted at a Tertiary Diabetes Centre in Vienna, Austria.

PATIENTS:

A cohort with all people with T1DM (n = 641, 47% females, 30 ± 11 years) attending their annual diabetes review was created in 1983-1984. Biomedical data were collected.

MAIN OUTCOME MEASURES:

In 2013 we investigated mortality rates and incidence rates of RRT by record linkage with national registries and incidence of other major diabetes complications by questionnaire.

RESULTS:

156 (24%) patients died [mortality rate: 922 (95%CI: 778-1066) per 100 000 person years]. Fifty-five (8.6%) received RRT [incidence rate: 335 (95%CI: 246-423) per 100 000 person years]. The 380 questionnaires (78% return rate) recorded cardiac events, strokes, limb amputations, and/or blindness, affecting 21.8% of survivors. Mortality and incidence of RRT increased in each quartile of baseline HbA1c, with the lowest rates in the quartile with HbA1c ≤ 6.5% (48 mmol/mol) (P < .05).

CONCLUSIONS:

In people with established type 1 diabetes who were observed for almost three decades, the overall mortality was 24% and the incidence of renal replacement therapy was 8.6%, with a 21.8% combined incidence rate of the other hard endpoints in the surviving people. A clear linear relationship between early glycemic control and the later development of end stage renal disease and mortality has been found.

PMID:
25247465
DOI:
10.1210/jc.2014-2701
[Indexed for MEDLINE]

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