High Risk of Renal Dysfunction in Patients with Fulminant Type 1 Diabetes

Aims/Introduction To compare the incidence rate of renal dysfunction between patients with fulminant type 1 diabetes and those with acute-onset type 1 diabetes. Materials and Methods The present retrospective cohort study included patients with fulminant type 1 diabetes and acute-onset type 1 diabetes diagnosed during April 1993 to March 2016 at a national center in Japan. Glycated hemoglobin levels, incidence rates of renal dysfunction defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2 and microalbuminuria were examined. Results In total, 115 patients with type 1 diabetes (10 with fulminant type 1 diabetes and 105 with acute-onset type 1 diabetes) were included. The median glycated hemoglobin levels were significantly lower in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes 0, 3, 6 and 9 years after diabetes onset (6.5 vs 12.7%, 6.5 vs 7.9%, 6.7 vs 8.2%, 7.5 vs 8.5%, respectively). Kaplan–Meier analysis showed a significantly higher incidence rate of renal dysfunction in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes (hazard ratio 1.72, 95% confidence interval 1.01–2.97, P = 0.037). The incidence rate of microalbuminuria did not significantly differ between the groups (hazard ratio 0.97, 95% confidence interval 0.34–2.77, P = 0.95). Sensitivity analysis using age- and sex-matched patients with fulminant type 1 diabetes and acute-onset type 1 diabetes yielded similar results. Conclusions The risk of developing renal dysfunction is higher in patients with fulminant type 1 diabetes than in those with acute-onset type 1 diabetes, despite better glycemic control.