The Long-Term Risks of End Stage Renal Disease and Mortality among First Nations and Non-First Nations People with Youth-Onset Diabetes

      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

      To read this article in full you will need to make a payment

      References

        • Wild S.
        • Roglic G.
        • Green A.
        • et al.
        Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Naqshbandi M.
        • Harris S.B.
        • Esler J.G.
        • Antwi-Nsiah F.
        Global complication rates of type 2 diabetes in Indigenous peoples: A comprehensive review.
        Diabetes Res Clin Pract. 2008; 82: 1-17
        • Dean H.J.
        • Mundy R.L.
        • Moffatt M.
        Non-insulin dependent diabetes mellitus in Indian children in Manitoba.
        Can Med Assoc J. 1992; 147: 52-57
        • Dean H.J.
        • Sellers E.A.C.
        • Young T.K.
        Type 2 diabetes in youth in Manitoba, Canada, 1986-2002.
        Can J Diabetes. 2003; 27: 449-454
        • Young T.K.
        • Martens P.J.
        • Taback S.P.
        • et al.
        Type 2 diabetes mellitus in children: Prenatal and early infancy risk factors among native Canadians.
        Arch Pediatr Adolesc Med. 2002; 156: 651-655
      1. Sellers EAC, Hadjiyannakis S, Amed S, et al. Minimum prevalence of persistent albuminuria in youth <18 years of age with type 2 diabetes mellitus: A Canadian Paediatric Surveillance Program Study. Chicago, IL: American Diabetes Association Meeting, June 2013.

        • Dyck R.F.
        • Osgood N.D.
        • Gao A.
        • Stang M.R.
        The epidemiology of diabetes mellitus among First Nations and non-First Nations children in Saskatchewan.
        Can J Diabetes. 2012; 36: 19-24https://doi.org/10.1016/j.jcjd2011.11.001
        • Dyck R.F.
        • Osgood N.D.
        • Lin T.H.
        • et al.
        End-stage renal disease in people with diabetes: A comparison of First Nations people and other Saskatchewan residents from 1981-2005.
        Can J Diabetes. 2010; 34: 324-333
        • Jiang Y.
        • Osgood N.
        • Lim H.J.
        • Dyck R.F.
        Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes: A competing risks analysis.
        Can Med Assoc J. 2014; 186: 103-109
        • Dyck R.F.
        • Osgood N.
        • Lin T.H.
        • et al.
        Epidemiology of diabetes mellitus among First Nations and non-First Nations adults.
        Can Med Assoc J. 2010; 182: 249-256
        • Clatworthy S.J.
        Re-assessing the population impacts of Bill C-31: Strategic research and analysis directorate.
        Indian and Northern Affairs Canada, Ottawa, Ontario2004
      2. Statistics Canada. 2001 census Aboriginal population profiles. 2002. Released June 17, 2003. Last modified 11/30, 2005. Statistics Canada Catalogue no. 93F0043XIE.

      3. Saskatchewan Health covered population 2007: Saskatchewan Health, Regina. http://www.health.gov.sk.ca/covered-population2007/csv.htm. June 2007. Accessed October 2008.

        • Hux J.E.
        • Ivis F.
        • Flintoft V.
        • et al.
        Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm.
        Diabetes Care. 2002; 25: 512-516
        • Guttmann A.
        • Nakhla M.
        • Henderson M.
        • et al.
        Validation of a health administrative data algorithm for assessing the epidemiology of diabetes in Canadian children.
        Pediatr Diabetes. 2010; 11: 122-128
        • Amed S.
        • Dean H.J.
        • Panagiotopoulos C.
        • et al.
        Type 2 diabetes, medication-induced diabetes, and monogenic diabetes in Canadian children: A prospective national surveillance study.
        Diabetes Care. 2010; 33: 786-791
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Forsblom C.
        • Harjutsalo V.
        • Thorn L.M.
        • et al.
        on behalf of the FinnDiane Study Group. Competing-risk analysis of ESRD and death among patients with type 1 diabetes and macroalbuminuria.
        J Am Soc Nephrol. 2011; 22: 537-544
        • Pintilie M.
        Competing risks: A practical perspective.
        John Wiley and Sons, Chichester2006
        • Gray R.J.
        A class of K-sample tests for comparing the cumulative incidence of a competing risk.
        Ann Statis. 1988; 16: 1141-1154
        • Dart A.
        • Sellers E.A.
        • Martens P.J.
        • et al.
        High burden of kidney disease in youth-onset diabetes.
        Diabetes Care. 2012; 35: 1265-1271
        • Lee E.T.
        • Lu M.
        • Bennett P.H.
        • Keen H.
        • the WHO Multinational Study Group
        Vascular disease in younger-onset diabetes: Comparison of European, Asian and American Indian cohorts of the WHO multinational study of vascular disease in diabetes.
        Diabetologia. 2001; 44: S78-S81
        • Barroso I.
        Genetics of type 2 diabetes.
        Diabetes Med. 2005; 22: 517-535
        • Dabalea D.
        • Pettitt D.J.
        Intrauterine diabetic environment confers risk for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility.
        J Pediatr Endocrinol Metab. 2001; 14: 1085-1091
        • Osgood N.D.
        • Dyck R.F.
        • Grassmann W.K.
        The inter- and intra-generational impact of gestational diabetes on the epidemic of type 2 diabetes.
        Am J Pub Health. 2011; 101: 173-179
        • Nelson R.G.
        • Morgenstern H.
        • Bennett P.H.
        Intrauterine diabetes exposure and the risk of renal disease in diabetic Pima Indians.
        Diabetes. 1998; 47: 1489-1493
        • Dyck R.F.
        • Klomp H.
        • Tan L.K.
        • Stang M.R.
        An association of maternal age and birth weight with end-stage renal disease in Saskatchewan.
        Am J Nephrol. 2003; 23: 395-402
        • Dyck R.F.
        • Bingham W.T.
        • Lim H.
        • et al.
        Decreased urine albumin:creatinine ratios in infants of diabetic mothers: Does exposure to diabetic pregnancies alter fetal renal development?.
        J Dev Orig Health Dis. 2011; 2: 265-271
        • Deved V.
        • Jette N.
        • Quan H.
        • et al.
        • for the Alberta Kidney Disease Network
        Quality of care for First Nations and non-First Nations people with diabetes.
        Can J Am Soc Nephrol. 2013; https://doi.org/10.2215/CJN.10461012
      4. Klomp H, Dyck RF, Sidhu N, et al. Measuring quality of diabetes care by linking health care system administrative databases with laboratory data. BMC Res Notes. www.biomedcentral.com/1756-0500/3/233. Accessed January 2014.

        • Dyck R.F.
        • Naqshbandi Hayward M.
        • Harris S.B.
        • on behalf of the CIRCLE Study Group
        Prevalence, predictors and co-morbidities of chronic kidney disease among First Nations adults with diabetes: Results from the CIRCLE study.
        BMC Nephrol. 2012; 13: 57https://doi.org/10.1186/1471-2369-13-57
        • Sellers E.A.C.
        • Blydt-Hanson T.D.
        • Dean H.J.
        • et al.
        Macroalbuminuria and renal pathology in First Nation youth with type 2 diabetes.
        Diabetes Care. 2009; 32: 786-790
        • Orchard T.J.
        • Secrest A.M.
        • Miller R.G.
        • Costacou T.
        In the absence of renal disease, 20-year mortality risk in type 1 diabetes is comparable to that of the general population: A report from the Pittsburgh Epidemiology of Diabetes Complications Study.
        Diabetologia. 2010; 53: 2312-2319
        • Mendelson M.
        • Cloutier J.
        • Spence L.
        • et al.
        Obesity and type 2 diabetes in a birth cohort of First Nations children born to mothers with pediatric-onset type 2 diabetes.
        Pediatr Diabetes. 2011; 12: 219-228
        • Pavkov M.E.
        • Bennett P.H.
        • Knowler W.C.
        • et al.
        Effect of youth-onset type 2 diabetes mellitus on end-stage renal disease and mortality in young and middle-aged Pima Indians.
        JAMA. 2010; 296: 421-426
        • Parving H.H.
        • Hommel E.
        • Smidt U.M.
        Protection of kidney function and decrease in albuminuria by captopril in insulin dependent diabetics with nephropathy.
        BMJ. 1988; 297: 1086-1091