American Diabetes Association
Morton_DC21-0220_Online-Only_Supplemental_Material_Clean_changes.pdf (522.27 kB)

Projecting the Incidence of Type 2 Diabetes–Related End-Stage Kidney Disease Until 2040: A Comparison Between the Effects of Diabetes Prevention and the Effects of Diabetes Treatment

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posted on 2021-05-21, 05:30 authored by Jedidiah I Morton, Stephen P McDonald, Agus Salim, Danny Liew, Jonathan E Shaw, Dianna J Magliano
Objective: This study sought to examine the effects of two diabetes prevention approaches and of widespread use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) among people with diabetes on the future incidence of diabetes-related end-stage kidney disease (ESKD-D).

Research Design and Methods: We developed a life table model to project the incidence of ESKD-D for type 2 diabetes in Australia until 2040. We projected incident ESKD-D under three separate scenarios: a large-scale lifestyle modification program for diabetes prevention; a population-wide sugar-sweetened beverage tax for diabetes prevention; and widespread use of SGLT2is among people with diabetes.

Results: Assuming current trends, the annual incidence of ESKD-D was projected to increase from 3.7 per 100,000 of the general population in 2014 to 5.7 by 2040. Incorporating the diabetes prevention approaches, the annual incidence of ESKD-D was projected to be between 5.2 and 5.5 per 100,000 population by 2040. When we modelled scenarios in which 50% and 70% of eligible people with diabetes were prescribed an SGLT2i, the annual incidence of ESKD-D by 2040 was projected to be 4.7 and 4.3 per 100,000 population, respectively. SGLT2is were projected to reduce the total number of incident ESKD-D cases between 2020 and 2040 by 12-21% compared to current trends, whereas diabetes prevention reduced cases by 1-3%.

Conclusions: It is likely that the number of people developing ESKD-D will increase over the coming decades, although widespread SGLT2i use will be effective at limiting this increase. Diabetes prevention will be crucial to prevent an ever-increasing burden of diabetes complications.


J.I.M is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. JES is supported by a National Health and Medical Research Council Investigator Grant. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government’s Operational Infrastructure Support Program. The ANZDATA Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health and Kidney Health Australia.