Risk of rapid progression to dialysis in patients with type 2 diabetes mellitus with and without diabetes-related complications at diagnosis Original paper
Researched by:
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Dr. Umar
ID
Dr. Umar
Read MoreClinical Pharmacist and Clinical Pharmacy Master’s candidate focused on antibiotic stewardship, AI-driven pharmacy practice, and research that strengthens safe and effective medication use. Experience spans digital health research with Bloomsbury Health (London), pharmacovigilance in patient support programs, and behavioral approaches to mental health care. Published work includes studies on antibiotic use and awareness, AI applications in medicine, postpartum depression management, and patient safety reporting. Developer of an AI-based clinical decision support system designed to enhance antimicrobial stewardship and optimize therapeutic outcomes.
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Dr. Umar
Read More
Researched by:
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Dr. Umar
ID
Dr. Umar
Read More
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Dr. Umar
What was studied?
This study examined the rapid progression to dialysis in adults with newly diagnosed type 2 diabetes mellitus, focusing on how diabetes-related complications at diagnosis influence this risk. The analysis used nationwide health insurance data from Taiwan to follow over one million individuals for five years, determining whether early complications dramatically accelerate kidney decline leading to dialysis. Because rapid progression to dialysis is a clinical endpoint shaped strongly by metabolic dysfunction, chronic inflammation, and vascular injury, this research helps clarify how early disease severity signals later renal failure risk. This question also echoes the broader clinical challenge of detecting metabolically driven tissue damage early—an issue aligned with understanding systemic microbiome-linked metabolic stress, though the present study did not directly assess microbiome signatures.
Who was studied?
The population included 1,016,018 adults in Taiwan diagnosed with type 2 diabetes between 2005 and 2013, all aged ≥20 years and free of prior renal failure or transplant. Of these, 25.38% already had at least one diabetes-related complication at diagnosis, including neuropathy, retinopathy, and nephropathy. Individuals were tracked for five years to determine whether dialysis was initiated, using Taiwan’s Registry of Catastrophic Illness. This large cohort provided detailed demographic, socioeconomic, and comorbidity data, allowing the study to explore how disease severity, represented by the Diabetes Complications Severity Index (DCSI), predicts renal outcomes. The dataset’s scale supports strong generalizability for populations with high diabetes prevalence and delayed diagnosis.
Most important findings
The presence and severity of complications at diabetes diagnosis strongly predicted renal decline. Patients with complications had a 9.55-fold higher risk of requiring dialysis within five years compared with those without complications. Higher DCSI scores were associated with stepwise increases in dialysis risk, rising to a 67.56-fold increase among individuals with scores ≥5. Those with three or more complications had a 36.12-fold increased risk, demonstrating that cumulative organ damage sharply accelerates kidney failure. While not directly assessed, these findings intersect with microbiome-related pathophysiology: systemic inflammation, metabolic endotoxemia, and immune dysregulation—often microbiome-linked—are known accelerants of microvascular and renal injury. The study’s dataset reveals clear phenotypic patterns that may later map onto specific microbial signatures associated with nephropathy-prone metabolic states.
| Predictor Category | Comparator | Increased Dialysis Risk | Interpretation |
|---|---|---|---|
| Complications at diagnosis | None | 9.55× | Early damage signals aggressive disease trajectory |
| DCSI score = 1 | Score 0 | 1.97× | Mild early injury already increases risk |
| DCSI score ≥5 | Score 0 | 67.56× | Severe multi-system injury predicts rapid decline |
| ≥3 complications | None | 36.12× | Multiple organ involvement elevates renal vulnerability |
Key implications
Rapid progression to dialysis is far more likely when diabetes is diagnosed after complications have already begun, highlighting missed opportunities for early detection. Clinically, this reinforces the need for aggressive screening, early glycemic control, and perhaps metabolic-inflammation assessments. Although microbiome data were not included, the patterns observed parallel known microbially influenced processes such as endothelial dysfunction and chronic immune activation. A future microbiome-signatures database could integrate phenotypes like high DCSI scores or early nephropathy to identify microbial patterns that precede tissue damage, enabling pre-clinical risk prediction.
Citation
Shih HM, Tsai WC, Wu PY, Chiu LT, Kung PT. Risk of rapid progression to dialysis in patients with type 2 diabetes mellitus with and without diabetes-related complications at diagnosis. Scientific Reports. 2023;13:16366. doi:10.1038/s41598-023-43513-z