title: High risk of renal dysfunction in patients with fulminant type 1 diabetes.
abstract: OBJECTIVE
  To compare the incidence rate of renal dysfunction between patients with fulminant type 1 diabetes and those with acute-onset type 1 diabetes.
  
  
  METHODS
  The present retrospective cohort study included patients with fulminant type 1 diabetes and acute-onset type 1 diabetes diagnosed during April 1993 to March 2016 at a national center in Japan. Glycated hemoglobin levels, incidence rates of renal dysfunction defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2and microalbuminuria were examined.
  
  
  RESULTS
  In total, 115 patients with type 1 diabetes (10 with fulminant type 1 diabetes and 105 with acute-onset type 1 diabetes) were included. The median glycated hemoglobin levels were significantly lower in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes 0, 3, 6 and 9 years after diabetes onset (6.5 vs 12.7%, 6.5 vs 7.9%, 6.7 vs 8.2%, 7.5 vs 8.5%, respectively). Kaplan-Meier analysis showed a significantly higher incidence rate of renal dysfunction in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes (hazard ratio 1.72, 95% confidence interval 1.01-2.97, P = 0.037). The incidence rate of microalbuminuria did not significantly differ between the groups (hazard ratio 0.97, 95% confidence interval 0.34-2.77, P = 0.95). Sensitivity analysis using age- and sex-matched patients with fulminant type 1 diabetes and acute-onset type 1 diabetes yielded similar results.
  
  
  CONCLUSIONS
  The risk of developing renal dysfunction is higher in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes, despite better glycemic control.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.|Department of Internal Medicine, Graduate School of Medicine and Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Tetsuro
authors.identifier: http://orcid.org/0000-0002-0230-1718
authors.initials: T
authors.lastname: Tsujimoto
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Chujo
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000097:blood / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Fulminant type 1 diabetes; Microalbuminuria; Renal dysfunction