Death, end-stage renal disease and renal function decline  in patients with diabetic nephropathy in French cohorts of type 1  and type 2 diabetes.
OBJECTIVE
Microvascular complications are a common feature of diabetes but additional research is needed regarding diabetic nephropathy endpoints in type 1 and type 2 diabetes.


METHODS
We compared 277 type 1 diabetes patients with 942 type 2 diabetes patients, with clinical proteinuria and no endstage renal disease (ESRD) at baseline, prospectively followed for death, ESRD and decline in estimated glomerular filtration rate (eGFR, all available measures).


RESULTS
The incidence rate of death was 67.0 (95% CI 59.2, 74.8) vs. 24.6 (95% CI, 19.0, 30.2) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for death was greater for type 2 diabetes patients (HR 3.423; 95% CI, 2.501, 4.683; p<0.0001), but the difference did not persist after adjustment for age (HRage-adj 0.859; 95% CI 0.581, 1.269; p=0.445). The incidence rate of ESRD was 18.4 (95% CI 14.2, 22.5) vs. 47.1 (95%CI 38.4, 55.9) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for ESRD was lower in type 2 diabetes (HR 0.399; 95% CI 0.287, 0.554; p<0.0001), but the difference did not persist after adjustment for sex, age and baseline serum creatinine (HRadj 0.989; 95% CI 0.597, 1.639; p=0.965). In a mixed linear model, eGFR decline was not significantly different in type 2 vs. type 1 diabetes (difference in slope −0.19 [0.28] ml min(−1) 1.73 m(−2) year(−1); p=0.512).


CONCLUSIONS
In diabetic nephropathy, once baseline risk factors were taken into account the risk for death, ESRD and renal function decline did not significantly differ between type 1 diabetes and type 2 diabetes.
Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France. samy.hadjadj@gmail.com.|CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France. samy.hadjadj@gmail.com.|CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France. samy.hadjadj@gmail.com.|Inserm, CIC1402 and U1082, Poitiers, France. samy.hadjadj@gmail.com.|CHU de Poitiers, Service d'Endocrinologie-Diabetologie and Centre d'Investigation Clinique, Rue de la Milétrie, 86000, Poitiers, France. samy.hadjadj@gmail.com.
Samy
S
Hadjadj
Department of Endocrinology, University Hospital of Nantes, Nantes, France.|Inserm, UMR1087-CNRS UMR6291, Institut du Thorax, Nantes, France.
Bertrand
B
Cariou
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France.|Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France.
Frederic
F
Fumeron
CHU de Poitiers, Pôle Dune, Poitiers, France.
Elise
E
Gand
Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.|CERITD, Evry, France.
Guillaume
G
Charpentier
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France.|Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France.
Ronan
R
Roussel
Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France.|CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.|Inserm, CIC1402 and U1082, Poitiers, France.
Ahmed-Amine
AA
Kasmi
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France.|Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Paris, France.
Jean-François
JF
Gautier
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France.|Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France.
Kammel
K
Mohammedi
CHU de Toulouse, Service de Diabétologie, Maladies Métaboliques et Nutrition, Toulouse, France.|Inserm, UMR1048/I2MC, Toulouse, France.|Université Paul Sabatier, UMR1048/I2MC, Toulouse, France.
Pierre
P
Gourdy
Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France.|CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France.|CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.|Inserm, CIC1402 and U1082, Poitiers, France.
Pierre-Jean
PJ
Saulnier
Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France.|CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France.|CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.|Inserm, CIC1402 and U1082, Poitiers, France.
Eva
E
Feigerlova
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, UMRS1138, Centre de Recherche des Cordeliers, Paris, France.|Diabetologie, Endocrinologie Nutrition, DHU FIRE, Hopital Bichat, AP-HP, Paris, France.
Michel
M
Marre
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011507:Proteinuria / Q000652:urine; D012307:Risk Factors