Diabetes mellitus in Tassin, France: Remarkable transformation in incidence and outcome of ESRD in diabetes

The incidence and prevalence of diabetes mellitus (DM) in the dialysis popu lation in Europe, and more especially in France, have been lagging behind t he impressive United States and Japanese rates. For a decade, things have b een changing, and the incidence of DM in hemodialysis (HD) reached almost 4 0% in Tassin, France in 1999. The prevalence has followed the same trend bu t increased more slowly. The increase in incidence and prevalence is almost totally accounted for by type 2 DM explosive outbreak and development. The morbidity on dialysis (hypotensive episodes, hospitalization number. and d uration) was significantly worse in diabetic patients (without difference b etween type 1 and 2) than in nondiabetic patients. The mortality rate was h igher in diabetic patients than in nondiabetic patients (mean half-life 3 a nd 13 years, respectively), even after adjustment for age and comorbidity. The mortality rate was higher in type 2 than in type 1 (mean half-life 2.7 and 5.2 years, respectively), a difference which disappears when adjusting for age and comorbidity. Specific causes of death were different in diabeti c and nondiabetic HD patients; in diabetics there was a six-fold higher car diovascular (CV) and three-fold higher infectious mortality, but there was the same mortality from cancer. A strong difference was observed between ty pe 1 and type 2 DM: in type 1 there was no increased infectious mortality a nd a moderately increased CV mortality compared with nondiabetic patients. Type 2 diabetic patients had a four-fold increased infectious and an eight- fold increased CV mortality. Altogether, the eruption of DM in our unit ove r the last decade has drastically increased the crude mortality, but the st andardized mortality ratio using the USRDS mortality table remained unchang ed, about 45% of expected mortality. (C) 2001 by the National Kidney Founda tion, Inc.