Divergent trends in the incidence of end-stage renal disease due to Type 1 and Type 2 diabetes in Europe, Canada and Australia during 1998-2002

Aims To describe the variation in geographical distribution of end‐stage renal disease (ESRD) due to Type 1 and Type 2 diabetes, and to calculate recent trends in incidence in predominantly white populations. Methods Estimation of age‐ and sex‐standardized incidence of ESRD by type of diabetes, and temporal trends, in population‐based data for persons aged 30–44, 45–54 or 55–64 years newly treated for ESRD during 1998–2002 in eight countries or regions of Europe, and Non‐Indigenous Canadians and Australians. Results The incidence of ESRD due to Type 1 diabetes at age 30–44 years correlated with published rates of childhood‐onset insulin dependent diabetes mellitus (P = 0.0025). ESRD due to Type 2 diabetes was uncommon before 45 years of age; in older persons, the highest rates (in Canada and Austria) were five times the lowest rates (in Norway and the Basque region). Rates of ESRD due to Type 1 diabetes fell, per year, by 6.4%[95% confidence interval (CI): 2.1–10.6%) in persons aged 30–44 years, and by 7.7% (95% CI: 2.4–12.7%] in those aged 45–54 years. In contrast, rates of ESRD due to Type 2 diabetes increased annually by 16% (95% CI: 5–28%) in the 30–44‐year age group, 11% (95% CI: 6–16%) at 45–54 years, and 9% (95% CI: 5–14%) at 55–64 years. Conclusions Modern prevention has reduced progression of nephropathy to ESRD due to Type 1 diabetes, but the continuing rise of ESRD due to Type 2 diabetes represents a failure of current disease control measures that has serious public health implications.