Young-onset diabetes poses a greater risk of end-stage renal disease (ESRD) than cardiovascular disease and stroke: a retrospective cohort study of UK Biobank

Background In the last three decades, in people with diabetes, while the mortality and morbidity due to cardiovascular disease (CVD) and stroke have declined, the incidence of end-stage renal disease (ESRD) has crept up. The precise cause for this shift is unknown. Intriguingly, during the same period, the incidence of diabetes in younger people has almost tripled worldwide. This study examines whether young-onset diabetes is a greater risk for ESRD compared to CVD and stroke. Methods We conducted this retrospective cohort study using data from volunteers (n = 502,408) aged 40–69 years recruited in UK Biobank between 2006 and 2010. The exposure variable was the age of diabetes diagnosis, while the outcomes of interest were ESRD, myocardial infarction, angina, and stroke. The cumulative follow-up period from the mean age of diabetes to the mean age of the outcomes of interest was 838,592 person-years. Univariate and multivariate logistic regression models were fitted to assess odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using receiver operating characteristics (ROC) analysis and calibration plots. Findings: Out of 26,206 people with diabetes, 1.16% (n = 303) had ESRD, 8.58% (n = 2250) had a myocardial infarction, 7.47% (n = 1958) had angina, and 2.94% (n = 771) had a stroke. Compared to later-onset, young-onset diabetes is linked with an earlier onset of ESRD. Based on the age of diabetes diagnosis, the univariate logistic regression showed that compared to those diagnosed after the age of 60, the odds of ESRD for those diagnosed at ages < 20, 20–40, and 41–60 years were OR [2.33 (95% CI 1.50–3.84), 7.78 (95% CI 4.81–13.16), and 5.26 (95% CI 3.00–9.40)], respectively. Myocardial infarction and stroke did not have a statistically significant relationship with diabetes diagnosis age. Multivariate models adjusted for sex and albuminuria confirmed the increased odds of ESRD in people with younger onset and longer duration of diabetes. Interpretation: People with younger onset and longer duration of diabetes are at a higher risk of ESRD than CVD and stroke.