Well, there are a lot of questions here – namely that people who have 50 years of T1D under their belt likely spend decades in the “dark ages” of diabetes care no matter what their A1C now. But I’m inclined to suspect these results are pointing to something here – that BG levels just aren’t the be-all end-all of complication prevention.
Maybe the issue is that we don’t screen for or treat micro- and macroalbuminaria before they show up, whereas someone who has progressed to ESRD has already been on established kidney failure treatments. Anyways, what do folks think? Do you think these results just don’t apply to the younger cohort with the disease, or those who have decades of good control?
I take studies like this with a grain of salt (pun intended). There are always more variables than accounted for, and to make such a blanket statement that “kidney disease is almost universal in 50+ year T1 diabetics” is pretty alarmist.
I do however strongly agree that risk factors must be controlled more aggressively in diabetics.
“We must, therefore, expand our focus to intensively manage other known kidney disease risk factors (eg, cholesterol, blood pressure)
In my own n=1 study, this “intensive management of risk factors” has been a major factor in my continued good health.
Btw, ESRD = End Stage Renal (kidney) Disease, the last stage of progression of kidney disease, when you need dialysis or a transplant – a dark word for me.
Some things I am noticing in the article:
In comparing patients diagnosed after 1965 with patients diagnosed between 1950 and 1965, researchers observed only a decline in ESRD — a 45% decrease by 40 years of diabetes duration. There were no declines in incidences of microalbuminuria or macroalbuminuria.
So, while the incidence of kidney disease in general remains the same, patients diagnosed later appear to suffer a lot less from ESRD, the worst stage. This may indicate that (a) because of more modern tech, they were treated better in their early stages of kidney disease, or (b) possibly their diabetes management was better, leading to less severity in kidney disease?
Onset before age 6 years was associated with the lowest risk, according to researchers, and incidence generally did not differ by sex.
This is interesting because counterintuitive and also going against the rest of the study. What this means is that, at equal D seniority (# of years since diagnosis) if you spend the bulk of your life as a diabetic, you are less likely to be affected by kidney disease than if you became a diabetic later in life. One (less interesting) possibility is that your body is younger at the same number of years of D, so you are less affected. Another possibility is that you learn to take better care of your self when diagnosed early on – that would be more optimistic.
The article does not mention if the authors correlated kidney disease incidence and progression to any metric linked to diabetes control – I am trying to get a hold of the paper to see the full data. Has anyone found it yet?
No, no diabetic kidney disease, but I am having a problem with my kidneys caused by difficulty in completely emptying my bladder. I learned this a few days ago, and I am scheduled for an ultrasound test next week.
The problem with countless papers throwing terrifying long-term statistics on us is that the percentage of T1D people with “decades of good control” has been (and still is) very low. Relatively newly diagnosed kids and adults with tools and means available to maintain very good control from the beginning will experience none of that. I have yet to see any evidence that there are risk factors associated with T1D beyond risks associated with prolonged exposure to (substantially) elevated bg levels.
well, except there are many case reports demonstrating that at least some people who are newly diagnosed and have always maintained relatively good control may still develop nerve damage, for instance.
And the fact that T2Ds and T1Ds develop complications at very different rates but similar A1Cs would suggest that BG control isn’t the whole story.
But there are also many cases of non-D people who develop nerve damage, or retinopathy, or have stokes, … Your second argument (T1D versus T2D with similar A1c) is much stronger. Will look into those papers - it’s not an easy comparison, they must be doing something wrong
