title: High burden of kidney disease in youth-onset type 2 diabetes.
abstract: OBJECTIVE
  To evaluate renal outcomes and survival in youth with type 2 diabetes (T2DM) versus type 1 diabetes (T1DM) versus nondiabetic control subjects.
  
  
  METHODS
  In total, 342 prevalent youth (aged 1-18 years) with T2DM, 1,011 youth with T1DM, and 1,710 control subjects identified from 1986 to 2007 were anonymously linked to health care records housed at the Manitoba Centre for Health Policy to assess long-term outcomes using ICD codes.
  
  
  RESULTS
  Youth with T2DM were found to have a fourfold increased risk of renal failure versus youth with T1DM. Risk factors associated with renal failure were renin angiotensin aldosterone system inhibitor use and albuminuria in adolescence. Compared with control subjects (age, sex, and postal code matched), youth with T2DM had a 23-fold increased risk of renal failure and a 39-fold increased risk of dialysis. Kaplan-Meier survival at 10 years was 91.4% in the type 2 diabetic group versus 99.5% in the type 1 diabetic group (P < 0.0001). Renal survival was 100% at 10 years in both groups. It decreased to 92.0% at 15 years and 55.0% at 20 years in the type 2 diabetic group but remained stable in the type 1 diabetic group (P < 0.0001).
  
  
  CONCLUSIONS
  Youth with T2DM are at high risk of adverse renal outcomes and death. Albuminuria and angiotensin aldosterone system inhibitor use, which may be a marker of severity of disease, are associated with poor outcomes in early adulthood.
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada. adart@hsc.mb.ca
authors.forename: Allison B
authors.initials: AB
authors.lastname: Dart
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sellers
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Marni D
authors.initials: MD
authors.lastname: Brownell
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Dean
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000419:Albuminuria / Q000652:urine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects*; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents