Pavkov ME et al. (2006) Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA 296: 421–426

The prevalence of youth-onset (i.e. at <20 years of age) type 2 diabetes has doubled, worldwide, in the past 30 years; Pima Indians from the Gila River Indian community (Arizona, US) have a particularly high incidence of type 2 diabetes, and members of this community have participated in a longitudinal, population-based study of this condition since 1965—the most complete, long-term follow-up of youth-onset diabetes reported, to date.

Pavkov and colleagues assessed 1,856 Pima Indians (1,089 women) with type 2 diabetes. Of these, 96 had youth-onset and 1,760 had older-onset (i.e. when aged 20–55 years) diabetes. Between 1965 and 2002, 148 individuals developed end-stage renal disease (ESRD). After adjustment for age and sex, the incidence of ESRD was almost fivefold higher in participants aged 25–54 years with youth-onset diabetes, than in similar-aged individuals with older-onset diabetes. Pavkov and colleagues also compared mortality from natural causes in diabetic and nondiabetic Pima Indians: after adjustment for age and sex, study participants with youth-onset diabetes had threefold-higher mortality than 4,189 nondiabetic individuals (and slightly, but not significantly, higher mortality than participants with older-onset diabetes). Fatal cardiovascular disease was associated with ESRD, but not with age at diabetes onset.

In middle-aged individuals with youth-onset diabetes, the increased incidence of serious, long-term complications was largely attributable to their prolonged duration of disease. Pavkov et al. suggest that treatment strategies should focus on delay or prevention of diabetes and diabetic nephropathy.