Cardio-renal Complications in Young-onset Type 2 Diabetes Compared Between White Caucasian and African American in USA

  

Objective: To explore risks and associated mediation effects of developing chronic kidney disease (CKD) and heart failure (HF) in young- and usual-onset T2DM among White Caucasian (WC) and African American (AA).

Research Design and Methods: From US medical records, 1,491,672 WC and 31,133 AA were identified and stratified by T2DM-onset age (18-39 /40-49 /50-59 /60-70 years). Risks, mediation effects and time to CKD and HF were evaluated adjusting for time-varying confounders.

Results: In 18-39, 40-49, 50-59, 60-70 year-groups, HR (95% CI) of developing CKD /HF in AA compared to WC were 1.21 (1.17-1.26) /2.21 (1.98-2.45), 1.25 (1.22-1.28) /1.86 (1.75-1.97), 1.21 (1.19-1.24) /1.54 (1.48-1.60), 1.10 (1.08-1.12) /1.11 (1.07-1.15) respectively. In AA /WC aged 18-39 years, time (CI) in years to CKD [8.7 (8.2-9.1) /9.7 (9.2-10.2)] and HF [10.3 (9.3-11.2) /12.1 (10.6-13.5)] were on average 3.6 /4.0 and 3.1 /4.1 years longer compared to those diagnosed at 60-70 years.

Compared to females, AA males aged <60 years had 11-49% higher CKD risk, while WC males aged <40 years had 23% higher and those aged 50+ had 7-14% lower CKD risk respectively. 

The mediation effects (%) of CKD on the HF risk difference between ethnicities across age-groups (range: 54-91%) were higher compared to those of HF on CKD risk difference between ethnicities across age-groups (range: 13-39%). 

Conclusions: Developing cardio-renal complications on average within 10 years of young-onset T2DM, and high mediation effect of CKD on HF call for revisiting guidelines on early diagnosis and pro-active treatment strategies for effective management of cardio-metabolic risk.