Abstract
Objective
To compare the long-term risks of end stage renal disease and death among First Nations
and non-First Nations people with youth-onset diabetes.
Methods
Using Saskatchewan Ministry of Health administrative databases covering the period
between 1980 and 2005, we conducted a retrospective cohort study of end stage renal
disease and death among youth with diabetes diagnosed before age 20. We developed
Fine and Gray sub-distribution hazards models and cumulative incidence functions for
the 2 outcomes by First Nations status and duration of diabetes.
Results
Incident cases of youth-onset diabetes were diagnosed in 352 First Nations and 2288
non-First Nations people. Mean ages at diabetes diagnoses were 11.7 and 11.2 years,
respectively (p=0.13). Adjusted for sex and age at diabetes diagnosis, the risk for
end stage renal disease was 2.59 (95% CI, 1.11–6.04) times higher, and the risk for
death 2.64 (95% CI, 1.44–4.87) times higher for First Nations compared to non-First
Nations people. After 25 years, the cumulative incidence of end stage renal disease
was 12.3% for First Nations people compared to 4.3% in their non-First Nations counterparts.
Corresponding mortality rates were 14.6% and 7.2%, respectively.
Conclusions
First Nations people with youth-onset diabetes experience higher long-term risks for
end stage renal disease and death than their non-First Nations counterparts. Early
identification of type 2 diabetes and secondary prevention of diabetic nephropathy
are feasible short-term goals for this high-risk group. More effective primary prevention
initiatives and programs to delay diabetes onset are imperative to reverse current
trends.
Résumé
Objectif
Comparer les risques à long terme d’insuffisance rénale terminale et de mortalité
des membres des Premières Nations et des non-membres des Premières Nations souffrant
de diabète juvénile.
Méthodes
À partir de la banque de données administratives du ministère de la Santé de la Saskatchewan
couvrant la période de 1980 à 2005, nous avons réalisé une étude de cohorte rétrospective
sur l’insuffisance rénale terminale et la mortalité des jeunes ayant reçu un diagnostic
de diabète avant l’âge de 20 ans. Nous avons développé des modèles à risques en sous-distribution
de Fine et Gray et les fonctions d’incidence cumulée de 2 critères de jugement selon
le statut auprès des Premières Nations et la durée du diabète.
Résultats
Les nouveaux cas de diabète juvénile ont été diagnostiqués chez 352 membres des Premières
Nations et 2288 non-membres des Premières Nations. L’âge moyen lors du diagnostic
de diabète était respectivement de 11,7 ans et de 11,2 ans (p = 0,13). Ajusté selon
le sexe et l’âge lors du diagnostic de diabète, le risque d’insuffisance rénale terminale
était 2,59 (IC à 95 %, 1,11-6,04) fois plus élevé et le risque de mortalité était
2,64 (IC à 95 %, 1,44-4,87) fois plus élevé chez les membres des Premières Nations
que chez les non-membres. Après l’âge de 25 ans, l’incidence cumulée de l’insuffisance
rénale terminale était de 12,3 % chez les membres des Premières Nations et de 4,3
% chez leurs homologues non-membres des Premières Nations. Les taux correspondants
de mortalité étaient respectivement de 14,6 % et de 7,2 %.
Conclusions
Les membres des Premières Nations souffrant de diabète juvénile connaissent des risques
à long terme plus élevés d’insuffisance rénale terminale et de mortalité que leurs
homologues non-membres des Premières Nations. Le dépistage précoce du diabète de type
2 et la prévention secondaire de la néphropathie diabétique font partie des objectifs
réalisables à court terme pour ce groupe exposé à un risque élevé. Des initiatives
et des programmes de prévention primaire plus efficaces pour retarder l’apparition
du diabète sont impératifs pour inverser les tendances actuelles.
Keywords
Mots clés
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Article Info
Publication History
Published online: June 28, 2014
Accepted:
March 23,
2014
Received in revised form:
March 20,
2014
Received:
February 8,
2014
Footnotes
Ying Jiang is currently with the Ontario Cancer Institute, but her work on this project stems from her position as a graduate student at the University of Saskatchewan.
Identification
Copyright
© 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
