This Article Full Text Full Text (PDF) All Versions of this Article: 91/10/3814    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stadler, M. Articles by Prager, R. Search for Related Content PubMed PubMed Citation Articles by Stadler, M. Articles by Prager, R. Related Collections Cardiovascular Endocrinology Diabetes and Insulin

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.

This article has been cited by other articles:

				V.-P. Makinen, C. Forsblom, L. M. Thorn, J. Waden, D. Gordin, O. Heikkila, K. Hietala, L. Kyllonen, J. Kyto, M. Rosengard-Barlund, et al. Metabolic Phenotypes, Vascular Complications, and Premature Deaths in a Population of 4,197 Patients With Type 1 Diabetes Diabetes, September 1, 2008; 57(9): 2480 - 2487. [Abstract] [Full Text] [PDF]

				D. M. Maahs and M. Rewers Mortality and Renal Disease in Type 1 Diabetes Mellitus--Progress Made, More to Be Done. J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3757 - 3759. [Full Text] [PDF]