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March 6, 2001


Question from Yorktown, New York, USA:

My eight year old son has diabetes, and I am very confused about the statistical information regarding long-term complications. I am most concerned about potential nephropathy. What are the most updated and reliable statistics that show what percentage of people with diabetes (type 1 versus type 2) get a kidney problem? How long have they had diabetes?


This is a difficult question to answer to answer accurately because the outlook is constantly improving. A recent survey in England found that, in a cross section of over 1000 children and adolescents with presumed type 1 diabetes, the incidence of microalbuminuria, the very earliest sign of nephropathy was a little less than 10%. What the study did not do, though, was to measure the additional impact of routine early detection of microalbuminuria and hypertension together with treatment with ACE inhibitors. At an even earlier stage, it has also been repeatedly shown that maintaining an hemoglobin A1c level of less than 7% will further and substantially reduce the risk of eventual renal involvement.


[Editor’s comment: You need to find out what the normal range for HbA1c is for the laboratory performing the test. There are several methods used in the testing, so, unfortunately, there is not a single normal range. You should strive to keep the level at less than 1% above the upper limit of normal, making sure there are not frequent or severe hypoglycemia.