title: Impact on mortality and incidence of end-stage renal disease of education and treatment at a diabetes center among patients with type 1 diabetes: comparison of two subgroups in the Japanese DERI cohort.
abstract: The aim of this study was to compare mortality and incidence of end-stage renal disease (ESRD) in patients with type 1 (insulin-dependent) diabetes who had attended a diabetes center with those who had not. The cohort consisted of a total of 1430 patients diagnosed with Type 1 diabetes at 18 years or younger, and between 1965 and 1979. This population-based cohort in Japan was subdivided into two groups: patients who had visited a large diabetes center in Tokyo (n=162) and those who had not (n=1212). Mortality and incidence of ESRD were compared between the two subgroups as of January 1, 1990. Crude mortality was 1.95 per 1000 person-years (95% CI: 0.49-5.06) for those who had visited the center and 6.05 (4.86-7.41) for those who had not. A multivariate Cox proportional hazard model showed that the patients who had visited the center were three times less likely to die (hazard ratio: 0.31, 95% CI: 0.10-0.98) than those who had not. Crude incidence of ESRD was 1.32 (0.22-4.09) and 5.86 (4.65-7.26) for those who had visited the center and for those who had not, respectively. After adjusting for covariates, the patients who had visited the center were five times less likely to develop ESRD (hazard ratio: 0.19, 0.05-0.78) than those who had not. Education and treatment of type 1 diabetes with an integrated management system under specialists and a multidisciplinary team appears to be associated with a better prognosis.
authors.affiliation: Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1, Kawada-cho, Shinjuku, Tokyo, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Uchigata
authors.forename: Keiko
authors.initials: K
authors.lastname: Asao
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.forename: Akiko
authors.initials: A
authors.lastname: Sato
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Toshika
authors.initials: T
authors.lastname: Otani
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kasahara
authors.forename: Hiroko
authors.initials: H
authors.lastname: Takaike
authors.forename: Maki
authors.initials: M
authors.lastname: Okudaira
authors.forename: Junnosuke
authors.initials: J
authors.lastname: Miura
authors.forename: Hitomi
authors.initials: H
authors.lastname: Takada
authors.forename: Kazuko
authors.initials: K
authors.lastname: Muto
authors.forename: Mari
authors.initials: M
authors.lastname: Osawa
authors.forename: Nobuo
authors.initials: N
authors.lastname: Matsuura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000046:Academic Medical Centers / Q000592:standards* / Q000639:trends; D000293:Adolescent; D044466:Asian People; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D015233:Models, Statistical; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D018579:Patient Selection; D018511:Systems Integration; D013997:Time Factors; D016896:Treatment Outcome