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Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset

Costacou T, Orchard TJ.

Diabetes Care. 2017 Sep 20. pii: dc171118. doi: 10.2337/dc17-1118.

Editorial comment by Vivian Fonseca

Over the last 2-3 decades glycemic control has improved in type 1 diabetes, and other advances in health care have led to improved life expectancy in this disease with a large number of patients living with the disease for > 50 years. This gives us an opportunity to study the long term effect of the disease, that previously resulted in premature death at a young age. Interestingly a proportion of people with type 1 diabetes remain free of complications, though most get some degree of microvascular disease.

This new study by Castacou and Orchard focuses on kidney disease in a cohort with long-standing disease. Despite a decline in rate of this complication in the last few years (perhaps related to widespread use of RAAS blockade), a significant proportion of patients develop end-stage renal disease (ESRD). Some of this may relate to hypoglycemia, complexity and cost of optimal treatment (pumps and CGMS etc.) leading to suboptimal control of both glucose and BP in a lot of patients. However, further research is needed to identify treatment targets beyond the RAAS system to treat advancing renal disease in patients with long standing diabetes. 

Diabetes Care. 2017 Sep 20. pii: dc171118. doi: 10.2337/dc17-1118. 

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