The Link Between Early Onset of Diabetes and Kidney Failure

A study in the July 26, 2006 issue of the Journal of the American Medical Association (JAMA) showed that young people who get obesity-related diabetes face a much higher risk of kidney failure and death by middle age than people who develop diabetes as adults. The research was conducted as part of the ongoing NIH study of type 2 diabetes in the Pima Indians of Arizona.

Onset of type 2 diabetes in participants younger than age 20 years was associated with a nearly five-fold increase in end-stage kidney disease compared with participants who had a later onset of diabetes. Of the 1,865 participants with type 2 diabetes, 96 developed it in childhood. During at least 15 years of follow-up, 15 of these people, or 16 percent, developed end-stage kidney failure or died from diabetic kidney disease by age 55. Among those who developed diabetes after age 20, 133 participants, or 8 percent, had these outcomes. The authors concluded that because youth-onset diabetes leads to substantially increased complication rates and mortality in middle age, efforts should focus on preventing or delaying the onset of diabetes.

Did you know that 83 percent of SDPI programs report they devote at least some of their SDPI funding to programs for prevention of diabetes in AI/AN youth? This study confirms the belief stated by the Tribal Leaders Diabetes Committee (TLDC) that one of their highest priorities should be the prevention of diabetes in AI/AN children and youth.

Pavkov et al. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA, Vol. 296, No. 4, July 26, 2006.

Healthy Lifestyle Changes Can Reduce Genetic Risk of Diabetes

Researchers have confirmed that a certain variation in a gene that puts people at higher risk for type 2 diabetes also was found in participants of the Diabetes Prevention Program (DPP), a large clinical trial of adults at increased risk for type 2 diabetes. They also found that even DPP study participants who had the highest genetic risk benefited from making healthy lifestyle changes designed to prevent the onset of diabetes, as much as, or perhaps even more than, those who did not inherit the variation in the gene.

Published in the July 20, 2006, issue of the New England Journal of Medicine (NEJM), this research provides even more support for the DPP’s earlier findings that people at risk for diabetes, whether they are overweight, have elevated blood glucose levels, or have a genetic predisposition, can benefit greatly by implementing a healthy lifestyle.

Launched in 1995, the DPP ended in 2001, a year earlier than planned because the results were so clear. The researchers published their main findings in 2002 (http://www.nih.gov/news/pr/feb2002/hhs-06.htm). The 3,234 people who took part in the study were adults with pre-diabetes, meaning they had blood glucose readings that were higher than normal but not yet in the diabetic range. Most were significantly overweight. Nearly half were minorities (171 were American Indian) who are at disproportionately high risk for diabetes.

In the DPP, study participants who lost 5 to 7 percent of their weight by cutting the fat content and calories in their diet and by increasing physical activity (e.g., walking 5 days a week 30 minutes a day) reduced the onset of type 2 diabetes by 58 percent. Treatment with the medication metformin lowered the chances of developing diabetes by 31 percent.

The DPP participants randomly assigned to lifestyle changes received guidance from a dietitian and a lifestyle coach during the study. Unfortunately, most adults at risk for diabetes don't have access to such support, however, more and more community-based programs, recreation centers, and our SDPI grantees are providing the types of lifestyle intervention approaches used in the DPP.

The IHS Special Diabetes Program for Indians’ Diabetes Prevention Program is based on the results of the DPP. These 36 competitive diabetes prevention demonstration projects are attempting to show that the results from this study can be used in AI/AN communities to prevent diabetes.

Florez, JC et al. TCF7L2 polymorphisms and progression to diabetes in the Diabetes Prevention Program. New England Journal of Medicine, Vol. 355, No. 3, July 20, 2006.