Prevalence and correlates of diabetic nephropathy in patients with youth onset diabetes in India (Abstract Number: AD-1544)

Background and aim: Data on the epidemiology of diabetic nephropathy in youth with diabetes are limited. The present study was designed to compare the prevalence of diabetic nephropathy and its risk factors among patients with young onset Type 1 and Type 2 diabetes.
Methods: We selected the study population from a multi centric clinic based registry of youth onset diabetes-YDR in India. Data of all patients with youth onset (age at diagnosis ≤ 25 years) Type 1 diabetes (n=2167) and T2DM (n=857), registered (from 2000 to 2012) at the Delhi (North India) and Chennai (South India) collaborating centres of the above registry were analysed. Diabetes was classified using symptom-based clinical criteria. Patients were labeled to have diabetic nephropathy if 24 hour urine protein excretion was greater than 500mg or urine albumin excretion greater than 300mg.
Results: Prevalence (95% C.I) of diabetic nephropathy was higher among patients with type 2 diabetes [6.4 % (4.8, 8.1)] compared to type 1 diabetes [3.0% (2.3, 3.8)]. The mean duration of diabetes since diagnosis (95% C.I) was significantly higher among those with nephropathy [Type 1 diabetes- 11.0 (8.7, 13.2); Type 2 diabetes-12.3 (9.4, 15.3)] compared to those without nephropathy [Type 1 diabetes- 3.0 (2.7, 3.2); Type 2 diabetes- 5.7 (5.1, 6.2)]. After adjusting for all the covariates, factors such as longer duration of diabetes since diagnosis and high blood pressure were independently associated with diabetic nephropathy in both type 1 and type 2 diabetes x(table-1). However, factors such as obesity and HbA1c did not show any association with the presence of diabetic nephropathy.
Discussion: Despite short duration of disease, there was a considerable burden of diabetic nephropathy among patients with youth onset diabetes in India, regardless of the diabetes type. This warrants early screening for diabetes complication in patients with youth onset diabetes.  



Table-1: Risk factors of diabetic nephropathy in youth onset diabetes 
Risk factors	                                             Type 1 diabetes                                        Type 2 diabetes
                                                           [Adjusted odds ratio (95% C.I)]	       [Adjusted odds ratio (95% C.I)]

Duration of diabetes 
since diagnosis (≥ 10 years)	                8.4 (4.1, 17.2)	                                     3.8 (2.1, 7.1)
Raised blood pressure	                         6.9 (3.6, 13.3)	                                     2.1(1.2, 3.7)

Prevalence and correlates of diabetic nephropathy among patients with youth onset type 1 and type 2 diabetes in India