Incidence of End-stage Renal Disease in Patients With Type 1 Diabetes

Finne, Patrik; Reunanen, Antti; Stenman, S; Groop, Per‐Henrik; Grönhagen‐Riska, Carola

doi:10.1001/jama.294.14.1782

Cited by 231 publications

(180 citation statements)

References 27 publications

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“…However, extrapolation of our results to all patients with type 1 diabetes showed that they incur more than 10% of all outpatient prescription medication costs. Although the incidence of ESRD has decreased [24,25], the number of ESRD patients is still increasing in Finland as well as worldwide due to the increasing incidence of diabetes, especially type 2 diabetes [26]. From this point of view, our findings together with previous studies highlight the importance of prevention, early diagnosis and intensive treatment of chronic kidney disease.…”

Section: Discussionsupporting

confidence: 61%

Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

2010

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Aims/hypothesis We examined the 11-year cumulative outpatient cost of prescription medication in patients with type 1 diabetes by subgroups according to the presence of complications and duration of diabetes. Methods This longitudinal study included a nationally representative cohort of patients with type 1 diabetes (N=3,717) from the Finnish Diabetic Nephropathy Study (FinnDiane). The data were linked to the Drug Prescription Register. The cumulative cost was calculated between 1998 and 2008. Information on complications was updated until 2008. Patients were divided into 10-year groups according to the duration of diabetes in 1998. Generalised linear mixed models under gamma distribution were used to evaluate the costs. Results Approximately 25% of the patients had macrovascular disease (MVD) and/or end-stage renal disease (ESRD). The adjusted cumulative cost of medications increased 56% when MVD was present compared with those without complications. In patients with ESRD or with both complications present the cost increased fourfold or 15-fold, respectively, when diabetes medications were excluded. The proportion of renal failure related medications (immunosuppressants, peritoneal dialytics and erythropoietin) accounted for more than 70% of these costs. The cost of diabetes medication was rather stable, irrespective of complication status or duration of diabetes. However, when complications were present these costs were markedly lower in all 10-year duration groups. Conclusions/interpretation This study shows that ESRD has a great impact on outpatient prescription medication costs. Since no considerable differences were observed in the cost of diabetes medication, the increase was completely due to the cost of medications related to comorbidity.

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Section: Discussionsupporting

confidence: 61%

Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

2010

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“…Previous studies have shown that age at onset of type 1 diabetes has an effect on the risk of microvascular complications, including diabetic nephropathy [1,2] and diabetic Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3816-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users. proliferative retinopathy [3].…”

Section: Introductionmentioning

confidence: 99%

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

2015

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Aims/hypothesis The aim of this study was to evaluate the relationship among age at onset of diabetes, age at onset of menarche and risk of diabetic nephropathy and laser-treated retinopathy in type 1 diabetes. Methods Data related to age at menarche were collected through questionnaires and were available for 1,304 women who participated in the Finnish Diabetic Nephropathy Study (FinnDiane). A possible association between age at menarche and diabetic nephropathy and retinopathy was investigated. Results There was an inverse relationship between the age at onset of diabetes and age at menarche: the younger the age at onset of diabetes, the higher the age at menarche (p<0.0001). A non-linear relationship between the age of menarche and risk of diabetic microvascular complications was found in patients with diabetes onset before menarche, but there was no such association in patients with diabetes onset after menarche. Women with delayed menarche (> mean age+2 years) had a 2.30 (95% CI 1.27, 4.17; p<0.006) times higher risk of nephropathy compared with the women who underwent menarche at the mean age±2 years. Delayed menarche also increased the risk of retinopathy (OR 2.34 [95% CI 1.36, 4.01]). After excluding patients with nephropathy, the OR for retinopathy was 2.11 (95% CI 1.15, 3.90). Earlier menarche (< mean age−2 years) did not have any effect on this risk. Conclusions/interpretation Delayed menarche was associated with an increased risk of diabetic nephropathy and retinopathy, whereas early menarche was not. Delayed menarche may be used as a new tool to identify women at risk of diabetic microvascular complications.

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“…Conditional probabilities for end-stage renal disease in people with microalbuminuria [13] and for death in people with end-stage renal disease were based on published literature.…”

Section: Microalbuminuria and End-stage Renal Diseasementioning

confidence: 99%

Development and validation of a cost–utility model for Type 1 diabetes mellitus

et al. 2015

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A simple cost-utility model was developed to evaluate new interventions for Type 1 diabetes mellitus by assessing the association between the interventions' effects on mean glycated haemoglobin and long-term complications and the risk of hypoglycaemic events. High-quality, recently reported data specific to people with Type 1 diabetes mellitus were identified by a systematic review. Methods: Through a systematic review, we identified complications associated with Type 1 DM and data describing the long-term incidence of these complications. An individual patient simulation model was developed and included the following complications: cardiovascular disease, peripheral neuropathy, microalbuminuria, end-stage renal disease, proliferative retinopathy, ketoacidosis, cataract, and adverse birth outcomes. Risk equations were developed from published cumulative incidence data and hazard ratios for the effect of glycated haemoglobin, age, and duration of diabetes. We validated the model by comparing model predictions with observed outcomes from studies used to build the model (internal validation) and from other published data (external validation). We performed illustrative analyses for typical patient cohorts and a hypothetical intervention.Results: Model predictions were within 2% of expected values in the internal validation and within 8% of observed values in the external validation (percentages represent absolute differences in the cumulative incidence). Conclusions:The model utilised high-quality, recent data specific to people with Type 1 DM. In the model validation, results deviated less than 8% from expected values.

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Incidence of End-stage Renal Disease in Patients With Type 1 Diabetes

Cited by 231 publications

References 27 publications

Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

Development and validation of a cost–utility model for Type 1 diabetes mellitus

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