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Long-Term Mortality and Incidence of Renal Dialysis and Transplantation in Type 1 Diabetes Mellitus

Division of Genetic Epidemiology (M.S., F.K.), Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck 6020, Austria; Third Medical Department of Metabolic Diseases and Nephrology (M.S., M.A., C.F., R.P.), Lainz Hospital, Vienna 1130, Austria; Ludwig Boltzmann Institute of Metabolic Diseases and Nutrition (M.S., T.K., C.F., K.I., R.P.), Vienna, Austria; Division of Endocrinology and Metabolism (C.A.), Department of Internal Medicine 3, Medical University Vienna, Vienna 1090, Austria; Austrian Dialysis and Transplantation Registry (R.K.), Klinikum Kreuzschwestern, Third Internal Department, Wels 4600, Austria; and Karl Landsteiner Institute of Metabolic Diseases and Nephrology (M.S., M.A., T.K., R.P.), Vienna, Austria

Address all correspondence and requests for reprints to: Marietta Stadler, M.D., Hietzing Hospital, Third Medical Department, Wolkersbergenstrasse 11130 Vienna, Austria. E-mail: marietta.stadler{at}wienkav.at.

Aims: We investigated long-term mortality and requirement of renal replacement therapy (RRT) in type 1 diabetes mellitus (T1DM) to study risk factors and late complication incidence of T1DM in a prospective cohort study at Lainz Hospital, Vienna, Austria.

Methods: In 1983–1984, T1DM patients [n = 648; 47% females, 53% males; age, 30 ± 11 yr; T1DM duration, 15 ± 9 yr; body mass index, 24 ± 4 kg/m²; glycated hemoglobin (HbA1c), 7.6 ± 1.6%] were stratified into HbA1c quartiles [1st, 5.9 ± 0.5% (range, 4.2–6.5%); 2nd, 6.9 ± 0.3% (6.6–7.4%); 3rd, 7.9 ± 0.3% (7.5–8.4%); and 4th, 9.6 ± 1.3% (8.5–14.8%)]. Twenty years later, both endpoints (death and RRT) were investigated by record linkage with national registries.

Results: At baseline, creatinine clearance, blood pressure, and body mass index were comparable among the HbA1c quartiles, whereas albuminuria was more frequent in the 4th quartile (+15%; P < 0.03). After the 20-yr follow-up, 13.0% of the patients had died [rate, 708 per 100,000 person-years (95% confidence interval, 557–859)], and 5.6% had received RRT [311 per 100,000 person-years (95% confidence interval, 210–412)]. Patients with the highest HbA1c values (4th quartile) had a higher mortality rate and a greater incidence of RRT (P < 0.04). In the Cox proportional hazards analysis, age, male gender, increased HbA1c, albuminuria, and reduced creatinine clearance were predictors of mortality (P < 0.05). Predictors of RRT were albuminuria (P < 0.001), reduced creatinine clearance (P < 0.001), and belonging to the 4th HbA1c quartile (P = 0.06). In Kaplan-Meier analysis, mortality was linearly associated with poor glycemia, whereas RRT incidence appeared to rise at a HbA1c threshold of approximately 8.5%.

Conclusion/Interpretation: In the Lainz T1DM cohort, 13.0% mortality and 5.6% RRT were directly associated with and more frequently found in poor glycemia, showing that good glycemic control is essential for the longevity and quality of life in T1DM.

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