, Volume 25, Issue 6, pp 496–501 | Cite as

Diabetic nephropathy in type 1 (insulin-dependent) diabetes: An epidemiological study

  • A. R. Andersen
  • J. Sandahl Christiansen
  • J. K. Andersen
  • S. Kreiner
  • T. Deckert


A follow-up of 1475 Type 1 (insulin-dependent) diabetic patients diagnosed before 1953 (815 males, 660 females) and before the age of 31 years was conducted. All patients were seen at the Steno Memorial Hospital and were referred from all parts of Denmark; 91 (6%) could not be traced. The rest (94%) were followed until death or for at least 25 years; 249 (17%) were followed for >40 years. Clinical diabetic nephropathy developed in 531 (41%) of the 1303 patients in whom sufficient information was available regarding proteinuria. Other causes of proteinuria were found in 3%, and 57% did not develop persistent proteinuria. The prevalence of diabetic nephropathy was 21% after 20–25 years of diabetes duration followed by a decline to 10% after 40 years. Two incidence peaks of the onset of proteinuria were seen, one after 16 and another after 32 years duration of diabetes. Incidence increased steeply 10 years after onset of diabetes and was low after 35 years duration. The cumulative incidence was 45% after 40 years of diabetes. A male preponderance was seen among patients with nephropathy. A significant difference in the pattern of annual incidence rates of diabetic nephropathy was seen, when groups with onset of diabetes before 1933, between 1933–1942, and 1943–1952, respectively, were compared. An association between daily insulin requirement and nephropathy incidence was found. Patients with nephropathy had a much poorer survival than those without proteinuria; 40 years after onset of diabetes, only 10% of patients who developed nephropathy were alive, whereas >70% of patients who did not develop nephropathy survived. Uraemia was the cause of death in 66% of the patients with nephropathy; 7 years after the onset of persistent proteinuria, 49% of the patients had died. It is concluded that diabetic nephropathy is the major life threatening complication in Type I diabetes of juvenile onset.

Key words

Type I diabetes diabetic nephropathy incidence prevalence prognosis 


  1. 1.
    Deckert T, Poulsen JE, Larsen M (1978) Prognosis of diabetics with diabetes onset before the age of thirty-one. Diabetologia 14: 363–377Google Scholar
  2. 2.
    Wilson JL, Root HF, Marble A (1951) Diabetic nephropathy. A clinical syndrome. N Engl J Med 245: 513–517Google Scholar
  3. 3.
    Kussman JM, Goldstein HH, Gleason RE (1976) The clinical course of diabetic nephropathy. JAMA 236: 1861–1863Google Scholar
  4. 4.
    Andersen AR, Andersen JK, Christiansen JS, Deckert T (1978) Prognosis for juvenile diabetics with nephropathy and failing renal function. Acta Med Scand 203: 131–134Google Scholar
  5. 5.
    Pirart J (1977) Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabet Metab 3: 97–107,174–182, 245–256Google Scholar
  6. 6.
    Thomsen AC (1965) The kidney in diabetes mellitus. Ph D Thesis, Munksgaard, CopenhagenGoogle Scholar
  7. 7.
    Entmacher PS, Root H, Marks HH (1964) Longevity of diabetic patients in recent years. Diabetes 13: 373–377Google Scholar
  8. 8.
    Watkins PJ, Blainey JD, Brewer DB, et al (1972) The natural history of diabetic renal disease: a follow-up study of a series of renal biopsies. Q J Med 41: 437–456Google Scholar
  9. 9.
    Balodimos MC (1971) Diabetic nephropathy. In: Marble A, White P, Bradley RF, Krall LP (eds) Joslin's diabetes mellitus, 11th ed. Lea and Febiger, Philadelphia, pp 526–528Google Scholar
  10. 10.
    Christau B, Kromann H, Christy M, Andersen OO, Nerup J (1979) Incidence of insulin-dependent diabetes mellitus (0–29 years at onset) in Denmark. Acta Med Scand [Suppl] 624: 54–60Google Scholar
  11. 11.
    Astrup P, Brøchner Mortensen K, Faber M (1959) Clinical laboratory techniques. August Bang, CopenhagenGoogle Scholar
  12. 12.
    Natvig H (1956) New height and weight tables for Norwegian women and men. Landsforeningen for kosthold og helse, OsloGoogle Scholar
  13. 13.
    Bishop YMM, Fienberg SE, Molland PW (1971) Discrete multivariate analysis. Theory and practice. M I T Press, Cambridge, MA, London, UK, pp 257–280Google Scholar
  14. 14.
    White P (1956) Natural course and prognosis of juvenile diabetes. Diabetes 5: 445–450Google Scholar
  15. 15.
    Finn R, Morner D (1979) Aetiological implications of sexratio in glomerulonephritis. Lancet 2: 1194Google Scholar
  16. 16.
    Christiansen JS (1978) Cigarette smoking and prevalence of microangiopathy in juvenile-onset insulin dependent diabetes mellitus. Diabet Care 1: 146–149Google Scholar
  17. 17.
    Ortved Andersen O (1976) Anti-insulin antibodies and late diabetic complications. Acta Endocrinol 83: 329–340Google Scholar
  18. 18.
    Eff C, Faber O, Deckert T (1978) Persistent insulin secretion, assessed by plasma C-peptide estimation in long-term juvenile diabetics with a low insulin requirement. Diabetologia 15: 169–172Google Scholar
  19. 19.
    Madsbad S, McNair P, Christensen MS, Christiansen C, Faber OK, Binder C, Transbøl I (1980) Influence of smoking on insulin requirement and metabolic status in diabetes mellitus. Diabetes Care 3: 41–43Google Scholar
  20. 20.
    Knowles HC (1971) Long-term juvenile diabetes treated with unmeasured diet. Trans Assoc Am Physicians 84: 95–100Google Scholar
  21. 21.
    Marks HH, Krall LP (1971) Onset, prognosis, and morbidity in diabetes mellitus. In: Marble A, White P, Bradley RF, Krall LP (eds) Joslin's diabetes mellitus, 11th ed. Lea and Febiger, Philadelphia, pp 209–254Google Scholar
  22. 22.
    Parving H-H, Andersen AR, Smidt UM, Svendsen PA (1983) Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1: 1175–1180Google Scholar

Copyright information

© Springer-Verlag 1983

Authors and Affiliations

  • A. R. Andersen
    • 1
    • 2
  • J. Sandahl Christiansen
    • 1
    • 2
  • J. K. Andersen
    • 1
    • 2
  • S. Kreiner
    • 1
    • 2
  • T. Deckert
    • 1
    • 2
  1. 1.Steno Memorial HospitalGentofte
  2. 2.Department for Data ProcessingCopenhagen County HospitalHerlevDenmark

Personalised recommendations