• Can J Diabetes · Aug 2014

    Comparative Study

    The long-term risks of end stage renal disease and mortality among First Nations and non-First Nations people with youth-onset diabetes.

    • Roland F Dyck, Ying Jiang, and Nathaniel D Osgood.
    • Department of Medicine, University of Saskatchewa, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewa, Saskatchewan, Canada. Electronic address: roland.dyck@usask.ca.
    • Can J Diabetes. 2014 Aug 1; 38 (4): 237-43.

    ObjectiveTo compare the long-term risks of end stage renal disease and death among First Nations and non-First Nations people with youth-onset diabetes.MethodsUsing Saskatchewan Ministry of Health administrative databases covering the period between 1980 and 2005, we conducted a retrospective cohort study of end stage renal disease and death among youth with diabetes diagnosed before age 20. We developed Fine and Gray sub-distribution hazards models and cumulative incidence functions for the 2 outcomes by First Nations status and duration of diabetes.ResultsIncident cases of youth-onset diabetes were diagnosed in 352 First Nations and 2288 non-First Nations people. Mean ages at diabetes diagnoses were 11.7 and 11.2 years, respectively (p=0.13). Adjusted for sex and age at diabetes diagnosis, the risk for end stage renal disease was 2.59 (95% CI, 1.11-6.04) times higher, and the risk for death 2.64 (95% CI, 1.44-4.87) times higher for First Nations compared to non-First Nations people. After 25 years, the cumulative incidence of end stage renal disease was 12.3% for First Nations people compared to 4.3% in their non-First Nations counterparts. Corresponding mortality rates were 14.6% and 7.2%, respectively.ConclusionsFirst Nations people with youth-onset diabetes experience higher long-term risks for end stage renal disease and death than their non-First Nations counterparts. Early identification of type 2 diabetes and secondary prevention of diabetic nephropathy are feasible short-term goals for this high-risk group. More effective primary prevention initiatives and programs to delay diabetes onset are imperative to reverse current trends.Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

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