, Volume 31, Issue 10, pp 730–736 | Cite as

Incidence of end-stage renal disease in Type 2 (non-insulin-dependent) diabetes mellitus in pima indians

  • R. G. Nelson
  • J. M. Newman
  • W. C. Knowler
  • M. L. Sievers
  • C. L. Kunzelman
  • D. J. Pettitt
  • C. D. Moffett
  • S. M. Teutsch
  • P. H. Bennett


The incidence of end-stage renal disease was determined in the Pima Indians of the Gila River Indian Community in Arizona, a population with a high prevalence of Type 2 (non-insulin-dependent) diabetes mellitus. Between 1975 and 1986, from a study population of 5059 subjects, end-stage renal disease occurred in 80 persons, 76 (95%) of whom had Type 2 diabetes. A review of the cases with end-stage renal disease indicated that among the diabetic subjects only two cases could be attributed to nondiabetic renal disease; all other cases were attributable to diabetic nephropathy. In diabetic Pima Indians the incidence rate of end-stage renal disease did not change during the study period, was similar in men and women, and was not effected by age at diagnosis of diabetes or by attained age, but did increase significantly with hypertension (p<0.05). The incidence of end-stage renal disease attributed to diabetic nephropathy increased from 0 cases/1000 person-years at 0–5 years to 40.8 cases/1000 person-years at ≥ 20 years duration of diabetes. In these subjects with Type 2 diabetes, the incidence rate of end-stage renal disease was similar to that in subjects with Type 1 (insulin-dependent) diabetes who were followed at the Joslin Clinic in Boston, Massachusetts when those with similar duration of diabetes were compared.

Key words

End-stage renal disease diabetic nephropathy Type 2 (non-insulin-dependent) diabetes incidence Pima Indians 


  1. 1.
    Eggers PW, Connerton R, McMullan M (1984) The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival. Health Care Financing Review 5: 69–88Google Scholar
  2. 2.
    Rettig B, Teutsch SM (1984) The incidence of end-stage renal disease in type I and type II diabetes mellitus. Diabetic Nephropathy 3: 26–27Google Scholar
  3. 3.
    Knowler WC, Bennett PH, Hamman RF, Miller M (1978) Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol 108: 497–505Google Scholar
  4. 4.
    Kamenetzky SA, Bennett PH, Dippe SE, Miller M, LeCompte PM (1974) A clinical and histologic study of diabetic nephropathy in the Pima Indians. Diabetes 23: 61–68Google Scholar
  5. 5.
    Pettitt DJ, Knowler WC, Lisse JR, Bennett PH (1980) Development of retinopathy and proteinuria in relation to plasmaglucose concentrations in Pima Indians. Lancet II: 1050–1052Google Scholar
  6. 6.
    Bennett PH, Burch TA, Miller M (1971) Diabetes mellitus in American (Pima) Indians. Lancet II: 825–828Google Scholar
  7. 7.
    World Health Organization (1985) Diabetes mellitus. Monograph Series No 727, GenevaGoogle Scholar
  8. 8.
    Kleinbaum DG, Kupper LL, Morgenstern H (1982) Epidemiologic research: principles and quantitative methods. Van Nostrand Reinhold, New York, pp 96–116Google Scholar
  9. 9.
    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748Google Scholar
  10. 10.
    Rothman KJ, Boice JD (1979) Epidemiologic analysis with a programmable Calculator. National Institutes of Health (NIH publication no. 79-1649), Washington, pp 11–17Google Scholar
  11. 11.
    Landis JR, Heyman ER Koch GG (1978) Average partial association in three-way contingency tables: a review and discussion of alternative tests. Int Stat Rev 46: 237–254Google Scholar
  12. 12.
    Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR (1985) The changing natural history of nephropathy in Type 1 diabetes. Am J Med 78: 785–794Google Scholar
  13. 13.
    Rostand SG, Kirk KA, Rutsky EA, Pate BA (1982) Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med 306: 1276–1279Google Scholar
  14. 14.
    Pugh JA, Stern MP, Haffner SM, Eifler CW, Zapata M (1988) Excess incidence of treatment of end-stage renal disease in Mexican Americans. Am J Epidemiol 127: 135–144Google Scholar
  15. 15.
    Harris MI, Hadden WC, Knowler WC, Bennett PH (1987) Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr. Diabetes 36: 523–534Google Scholar
  16. 16.
    Roseman JM (1985) Diabetes in Black Americans. In: Harris MI, Hamman RF (eds) Diabetes in America. National Institutes of Health (NIH publication no. 85-1468), Washington, VIII, pp 1–24Google Scholar
  17. 17.
    Gardner LI, Stern MP, Haffner SM, Gaskill SP, Hazuda HP, Relethford JH, Eifler CW (1984) Prevalence of diabetes in Mexican Americans: relationship to percent of gene pool derived from native American sources. Diabetes 33: 86–92Google Scholar
  18. 18.
    Stern MP (1985) Diabetes in Hispanic Americans. In: Harris MI, Hamman RF (eds) Diabetes in America. National Institutes of Health (NIH publication no. 85-1468), Washington, IX, pp 1–11Google Scholar
  19. 19.
    Hoy WE, Megill DM, Hughson MD (1987) Epidemic renal disease of unknown etiology in the Zuni Indians. Am J Kidney Dis 9: 485–496Google Scholar
  20. 20.
    Pasinski R, Pasinski M (1987) End-stage renal disease among the Zuni Indians: 1973–1983. Arch Intern Med 147: 1093–1096Google Scholar
  21. 21.
    Cameron JS, Challah S (1986) Treatment of end-stage renal failure due to diabetes in the United Kingdom, 1975–1984. Lancet II: 962–966Google Scholar
  22. 22.
    Parving HH, Andersen AR, Smidt UM, Oxenbøll B, Edsberg B, Sandahl Christiansen J (1983) Diabetic nephropathy and arterial hypertension. Diabetologia 24: 10–12Google Scholar
  23. 23.
    Mogensen CE, Christensen CK (1984) Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311: 89–93Google Scholar
  24. 24.
    Christlieb AR, Warram JH, Krolewski AS, Busick EJ, Ganda OP, Asmal AC, Soeldner JS, Bradley RF (1981) Hypertension: the major risk factor in juvenile-onset insulin-dependent diabetics. Diabetes 30 [Suppl. 2]: 90–96Google Scholar
  25. 25.
    Krolewski AS, Canessa M, Warram JH, Laffel LMB, Christlieb AR, Knowler WC, Rand LI (1988) Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. N Engl J Med 318: 140–145Google Scholar
  26. 26.
    Mangili R, Bending JJ, Scott G, Lai KL, Gupta A, Viberti GC (1988) Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. N Engl J Med 318: 146–150Google Scholar
  27. 27.
    Ballard DJ, Humphrey LL, Melton LJ, Frohnert PP, Chu C-P, O'Fallon WM, Palumbo PJ (1988) Epidemiology of persistent proteinuria in type II diabetes mellitus: population-based study in Rochester, Minnesota. Diabetes 37: 405–412Google Scholar
  28. 28.
    Knowler WC, Bennett PH, Nelson RG (1988) Prediabetic blood pressure predicts albuminuria after development of NIDDM. Diabetes 37 [Suppl.]: 120 (Abstract)Google Scholar
  29. 29.
    Herman WH, Teutsch SM (1985) Kidney diseases associated with diabetes. In: Harris MI, Hamman RF (eds) Diabetes in America. National Institutes of Health (NIH publication no. 85-1468), Washington, XIV, pp 1–31Google Scholar
  30. 30.
    Knowler WC, Bennett PH, Bottazzo GF, Doniach D (1979) Islet cell antibodies and diabetes mellitus in Pima Indians. Diabetologia 17: 161–164Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • R. G. Nelson
    • 1
  • J. M. Newman
    • 2
  • W. C. Knowler
    • 1
  • M. L. Sievers
    • 1
  • C. L. Kunzelman
    • 1
  • D. J. Pettitt
    • 1
  • C. D. Moffett
    • 3
  • S. M. Teutsch
    • 2
  • P. H. Bennett
    • 1
  1. 1.Diabetes and Arthritis Epidemiology SectionNational Institute of Diabetes and Digestive and Kidney DiseasesPhoenix
  2. 2.Division of Diabetes ControlCenters for Disease ControlAtlanta
  3. 3.Gila River Indian Community Human Resources DepartmentSacatonUSA

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