Incidence of Nephropathy in Insulin-Dependent Diabetes Mellitus as Related to Mortality and Cost-Benefit of Early Intervention

  • Knut Borch-Johnsen


Development of clinical diabetic nephropathy in IDDM-patients is associated with high excess mortality as well as with generalized vascular lesions and impairment in the cardiovascular risk profile of the individual. It therefore indicates a poor prognosis of the patient.


Diabetic Nephropathy Antihypertensive Treatment Excess Mortality Diabetes Duration Urinary Albumin Excretion Rate 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Borch-Johnsen K. The prognosis of insulin-dependent diabetes mellitus. Dan Med Bull 1989; 36: 336–348.PubMedGoogle Scholar
  2. 2.
    Diabetes Epidemiology Research International (DERI) Mortality Study Group. Major Cross-Country differences in risk of dying for people with IDDM. Diabetes Care 1991; 14: 49–54.CrossRefGoogle Scholar
  3. 3.
    Watson PJ, Blainey JD, Brewer DB, Fitzgerald MG, Malins JM, O’Sullivan DJ, Pinto JA. The natural history of diabetic renal disease. Q J Med 1972; 164: 437–456.Google Scholar
  4. 4.
    Borch-Johnsen K, Andersen PK, Deckert T. The effect of proteinuria on relative mortality in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1985; 28: 590–596.PubMedCrossRefGoogle Scholar
  5. 5.
    Borch-Johnsen K, Kreiner S, Deckert T. Mortality of Type 1 (insulin-dependent) diabetes mellitus in Denmark. Diabetologia 1986; 29: 767–772.PubMedCrossRefGoogle Scholar
  6. 6.
    Kofoed-Enevoldsen A, Borch-Johnsen K, Kreiner S, Nerup J, Deckert T. Declining incidence of persistent proteinuria in Type 1 (insulin-dependent)diabetic patients in Denmark. Diabetes 1987; 36: 205–209.PubMedCrossRefGoogle Scholar
  7. 7.
    Krolewski AS, Warram JH, Christlieb ARE, Busick EJ, Kahn CR. The changing natural history of nephropathy in Type 1 diabetes. Am J Med 1985; 78: 785–794.PubMedCrossRefGoogle Scholar
  8. 8.
    Viberti GC, Jarrett RJ, Mahmud U, Hill RD, Argyropoulos A, Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin dependent diabetes mellitus. Lancet 1982; i: 1430–1432.CrossRefGoogle Scholar
  9. 9.
    Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 1984; 311: 89–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Mathiesen ER, Oxenbøll B, Johansen K, Svendsen PAa, Deckert T. Incipient nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 1984; 26: 406–410.PubMedCrossRefGoogle Scholar
  11. 11.
    Jensen T. Albuminuria — a marker of renal and generalized vascular disease in insulin-dependent diabetes mellitus. Dan Med Bull 1991; 38: 134–144.PubMedGoogle Scholar
  12. 12.
    Feldt-Rasmussen B. Microalbuminuria and clinical nephropathy in Type 1 (insulin-dependent) diabetes mellitus: pathophysiological mechanisms and intervention studies. Dan Med Bull 1989; 36: 405–415.PubMedGoogle Scholar
  13. 13.
    Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1989; 32: 216–226.Google Scholar
  14. 14.
    Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 1984; 310: 356–336.PubMedCrossRefGoogle Scholar
  15. 15.
    Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ. Microalbuminuria predicts mortality in non-insulin-dependent diabetes. Diabetic Med 1984; 1: 17–19.PubMedCrossRefGoogle Scholar
  16. 16.
    Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1988; ii: 530–533.CrossRefGoogle Scholar
  17. 17.
    Damsgaard EM, Frøland A, Jørgensen OD, Mogensen CE. Micro-albuminuria as predictor of increased mortality in elderly people. BMJ 1990; 300: 297–300.PubMedCrossRefGoogle Scholar
  18. 18.
    Messent JWC, Elliott TG, Hill RD, Jarrett RJ, Keen H, Viberti GC. Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty year follow-up study. Kidney Int 1992; 41: 836–839.PubMedCrossRefGoogle Scholar
  19. 19.
    Marre M, Chatellier G, Leblanc H, Guyene TT, Menard J, Passa P. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ 1988; 297: 1092–1095.PubMedCrossRefGoogle Scholar
  20. 20.
    Mathiesen ER, Hommel E, Giese J, Parving H-H. Efficacy of captopril in postponing nephropathy in normotensive insulin-dependent diabetic patients with microalbuminuria. BMJ 1991; 303: 81–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Melbourne Diabetic nephropathy study group. Comparison between perindopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. BMJ 1991; 302: 210–216.CrossRefGoogle Scholar
  22. 22.
    Feldt-Rasmussen B, Mathiesen ER, Jensen T, Lauritzen T, Deckert T. Effect of improved metabolic control on loss of kidney function in Type 1 (insulin-dependent) diabetic patients: an update of the Steno studies. Diabetologia 1991; 34: 164–170.PubMedCrossRefGoogle Scholar
  23. 23.
    Marshall SM, Albert KGMM. Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin dependent diabetes. Q J Med 1989; 70: 61–71.PubMedGoogle Scholar
  24. 24.
    Borch-Johnsen K. Predictive value of microalbuminuria in long standing insulin dependent diabetes, (letter) BMJ 1993; 306: 271–272.PubMedCrossRefGoogle Scholar
  25. 25.
    Mogensen CE. Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. BMJ 1982; 285: 685–688.PubMedCrossRefGoogle Scholar
  26. 26.
    Parving H-H, Andersen ARE, Smidt UM, Svendsen PAA. Early aggressive antihypertensive treatment reduces the rate of decline in kidney function in diabetic nephropathy. Lancet 1983; i: 1175–1179.CrossRefGoogle Scholar
  27. 27.
    Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T. Improved survival in patients with diabetic nephropathy. Diabetologia 1989; 32: 884–886.PubMedCrossRefGoogle Scholar
  28. 28.
    Eggers PW. Health Care Policies/economics of the geriatric renal population. Am J Kidney Dis 1990; 16: 384–391.PubMedGoogle Scholar
  29. 29.
    Siegel JE, Krolewski AS, Warram JH, Weinstein MC. Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus. J Am Soc Nephrol 1992; 3: 3111–3119.Google Scholar
  30. 30.
    Borch-Johnsen K, Wenzel H, Viberti GC, Mogensen CE. Is screening and intervention for Microalbuminuria worthwhile in patients with insulin dependent diabetes? BMJ 1993; 306: 1722–1725.PubMedCrossRefGoogle Scholar
  31. 31.
    Ramlau-Hansen H, Bang Jespersen NC, Andersen PK, Borch-Johnsen K, Deckert T. Life insurance for insulin-dependent diabetics. Scand Actuarial J 1987; 19-36.Google Scholar
  32. 32.
    Kiberd BA, Jindal KK. Screening to prevent renal failure in insulin dependent diabetic patients: an economical evaluation. BMJ 1995; 311: 595–599.CrossRefGoogle Scholar
  33. 33.
    Microalbuminuria Collaborative Study Group, UK. Risk factors for development of microalbuminuria in insulin dependent diabetic patients: a cohort study. BMJ 1993; 306: 1235–1239.CrossRefGoogle Scholar
  34. 34.
    Hansen KW, Christensen CK, Andersen PH, Mau Pedersen M, Christiansen JS, Mogensen CE. Ambulatory blood pressure in microalbuminuric type 1 diabetic patients. Kidney Int 1992; 41: 847–854.PubMedCrossRefGoogle Scholar
  35. 35.
    Deckert T, Yokoyama H, Mathiesen ER, Rønn B, Jansen T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen JS. Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in insulin dependent diabetes. BMJ 1996; 312: 871–874.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Knut Borch-Johnsen
    • 1
  1. 1.Centre of Preventive MedicineGlostrupDenmark

Personalised recommendations