 
Diabetes Dateline
Fall 2006
Research News
Early Type 2 Diabetes Linked to Higher Kidney Failure, Mortality Risk
 People who develop type 2 diabetes before age 20 have substantially higher rates of kidney failure and mortality by middle age than those who develop diabetes after age 20, according to a recent study by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Researchers analyzed 37 years of data on a Southwestern American Indian tribe with an exceedingly
high rate of type 2 diabetes. Among 1,856 participants with diabetes, 96 had developed the disease before age 20.
Researchers found that people with youth-onset diabetes were eight times more likely to have kidney failure, or end-stage renal disease (ESRD), between the ages of 25 and 34 than those diagnosed after age 20. The youth-onset group also was five times more likely to have kidney failure between the ages of 35 and 44 and four times more likely to have ESRD between the ages of 45 and 54 than those who developed diabetes later in life.
The age-sex-adjusted death rate in participants with youth-onset diabetes was more than twice as high as in those with older-onset diabetes.
The results of this study are significant for other populations “because we’re seeing more people in all ethnic groups developing type 2 diabetes in youth,” according to Robert G. Nelson, M.D., Ph.D., an NIDDK researcher. “Those developing diabetes in youth will be confronting the complications of diabetes in midlife. At a time when most people their age are caring for children and aging parents and saving for retirement and their children’s college education, many of those with youth-onset diabetes may be needing care themselves.”
The study, “Effect of Youth-Onset Type 2 Diabetes Mellitus on Incidence of End-Stage Renal Disease
and Mortality in Young and Middle-Aged Pima Indians,” was published in the July 26, 2006, issue
of the Journal of the American Medical Association.
RBP4 Appears to Identify Insulin Resistance, Study Reveals
Findings from a recent study support the development of antidiabetic therapies aimed at lowering serum retinol-binding protein 4 (RBP4) levels. RBP4 is a protein secreted by fat cells and the liver that is elevated before clinically evident diabetes develops.
Researchers sought to determine whether serum RBP4 levels correlated with insulin resistance and changed after an intervention that improved insulin sensitivity. They found that serum RBP4 levels correlated with the magnitude of insulin resistance in patients with obesity, impaired glucose tolerance, or type 2 diabetes, and in nonobese, nondiabetic patients with a strong family history of type 2 diabetes.
Elevated serum RBP4 was associated with components of metabolic syndrome, including increased body mass index, waist-to-hip ratio, serum triglyceride levels, systolic blood pressure, and decreased high-density lipoprotein cholesterol levels.
Senior author Barbara Kahn and colleagues showed in a previous study that in mice, increasing serum RBP4 levels causes insulin resistance. “We do not yet know if RBP4 also causes insulin resistance in humans, but if it does, this will open up an entirely new mechanistic pathway underlying the pathogenesis of type 2 diabetes and the metabolic syndrome,” said Kahn, a professor of medicine at Harvard Medical School and chief of the division of endocrinology, diabetes, and metabolism at Beth Israel Deaconess Medical Center in Boston.
The study, “Retinol-binding Protein 4 and Insulin Resistance in Lean, Obese, and Diabetic Subjects,” was published in the June 15, 2006, issue of the New England Journal of Medicine.
[Top]
NIH Publication No. 07–4562
December 2006
|
