Endocrine Abstracts

Introduction

Uncontrolled hyperglycemia of diabetes is a common cause of renal failure and diabetic nephropathy, which is also called diabetic kidney disease (DKD). Despite improvements in the management of type 1 diabetes (T1D), progression of diabetic nephropathy remains unpredictable and associated with high morbidity and mortality. The objective of this study is to assess the prevalence and risk factors for diabetic kidney disease among adults-onset T1D.

Patients and methods

A retrospective study, from 2010 to 2019, including 166 patients diagnosed with T1D, occurred after the age of 20, with positive anti-pancreatic antibodies (Anti GAD, Anti ICA and /or Anti IA2). The incidence of DKD and its potential predictive factors were analyzed.

Results

Our study includes 71 women and 95 men, with mean diabetes duration of 7.34 ± 6.73 years (2 months-44.5 years).The mean age was 31.81 years. DKD was observed in 6% of patients after a mean diabetes duration of 23 ± 8.3 years.By the time of diagnosis of DKD, mean age was 41.7 ± 7.2 years. Approximately 80% of patients who had been diagnosed with DKD were hypertensive. The mean systolic and diastolic BP were 139.01 ± 24.55 mm Hg and 77 ± 11.6mmHg, respectively. The mean urea and creatinine levels were 16 ± 9.12 mmol/l and 241.6 ± 160.2 umol/l, respectively. Seven patients underwent hemodialysis for end-stage renal disease. Diabetes duration was a significant predictor of incident DKD (P < 0.05). T1D adults with diabetic nephropathy were older than those with normal renal function (41.7 ± 7.92 vs 31.18 ± 31.18 years; P < 0.05). Significant linear trends were observed for hig systolic and diastolic blood with increasing creatinine level (P < 0.05). Adults with diabetic retinopathy have a significant high prevalence of DKD (90%) (P < 0.05). DKD is significantly more prevalent among T1D adults who have been diagnosed with macrovascular compared to those without macrovascular damage (90% vs 2.6%; P < 0.05). High triglycerides and total cholesterol levels have also been associated with a heightened risk of DKD (P < 0.05).

Conclusion

Identification of predictive factors of DKD is a crucial step in the management of patients diagnosed with T1D during adulthood. Linear relationship of diabetic nephropathy was found with diabetes duration, age, macrovascular complications and perturbed lipid profile. Then, further studies are needed to better identify these factors and facilitate monitoring of T1D patients.