Epidemiology, development and treatment of end-stage renal failure in Type 2 (non-insulin-dependent) diabetes mellitus

Abstract

The prevalence of diabetes mellitus among patients treated for end-stage renal failure by dialysis in France was studied in two stages (UREMIDIAB Study). The first stage consisted of a questionnaire which was mailed to all dialysis centres in mainland France. The response rate was 80.8%, resulting in a study population of 12,903 patients. Of these patients 884 were declared diabetic (6.9%). Later 295 of them were interviewed by seven specially-trained physicians who checked the medical records together with the nephrologist in charge. Plasma C-peptide was measured in almost all of the patients. Effectively, 1.4% were found to have Type 1 diabetes and 5.5%, Type 2. Diabetic nephropathy was found to be the only primary renal diagnosis among 93.9% of Type 1 diabetic patients and 36.8% of Type 2. Of the latter 51.6% had a non-diabetic cause of renal failure. In the second stage a survey was later conducted in 13 of 14 dialysis centres located in the remote overseas French territories. Among 934 patients 1.04% were Type 1 diabetic and 19.67% Type 2 (22.9% altogether). Type 2 diabetic patients treated overseas were essentially non-Caucasians (92.6%). The sex ratio was 0.54 in the overseas territories vs 1.4 in the mainland. We conclude that the prevalence of diabetes among people on dialysis is low in mainland France. But there are striking differences in the prevalence of Type 2 diabetes among dialysis patients in mainland France and its overseas territories. These differences are not related to access to dialysis facilities.

Nutrition and Outcome on Renal Replacement Therapy of Patients with Chronic Renal Failure Treated by a Supplemented Very Low Protein Diet

“…Such a distribution is comparable with other data published for France (31,32) for the years 1985 to 1992 and with the findings of a recent study concerning more than 7000 French hemodialyzed patients (33). The low prevalence of diabetes is comparable to other published data from French patients (34). Renal function was not different in patients with CRF of different etiologies, but proteinuria was more severe in patients with diabetes and chronic glomerulonephritides.…”

Angiotensin‐I‐converting enzyme insertion/deletion polymorphism and high urinary albumin concentration in French Type 2 diabetes patients

“…In Type 2 diabetes patients with proteinuria, histological signs typical of diabetic nephropathy (Kimmelstiel–Wilson) are found in a minority of cases [27]. This situation contrasts with Type 1 diabetes, in which the vast majority of cases with proteinuria display diabetic nephropathy [28]. In Type 1 diabetes, ACE I/D polymorphism has been shown to be related to diabetic nephropathy, patients with the II genotype having a lower risk of nephropathy [11,29,30].…”

An Economic Analysis of Captopril in the Treatment of Diabetic Nephropathy

“…The natural history of patients with NIDDM and overt nephropathy is poorly understood, but data suggest that it is similar to that found in patients with IDDM who have reached the overt nephropathy stage (13)(14)(15)(16)(17). Thus, we used the same rate of progression for patients with NIDDM as was found for patients with IDDM in the captopril trial.…”