Projected number of diabetic renal disease patients among insulin-dependent diabetes mellitus children in Japan using a Markov model with probabilistic sensitivity analysis.

BACKGROUND To plan prevention programmes for the diabetic renal disease among insulin-dependent diabetes mellitus (IDDM) children, projections of future trends for the disease is crucial. We projected future trends in the number of diabetic renal disease patients among IDDM children and assessed an impact of treatment dissemination in Japan. METHODS We used a Markov model to describe the clinical courses of diabetic renal disease. Future trends in the number of patients with diabetic nephropathy (DN) and end-stage renal disease (ESRD) were projected from the year 1995 to 2015. We made three scenarios for assessing an impact of the dissemination of new treatment. We performed a probabilistic sensitivity analysis for the uncertainty of transition probabilities. RESULTS The results showed that the number of patients with DN was 790.5 (5th to 95th percentile: 652.5-955.1), ESRD was 253.3 (5th to 95th percentile: 207.3-310.0) in year 2015 on basic scenario. Considering the dissemination of intensive insulin therapy, under the scenario of the gradual increase of the treatment, the result showed that the number of patients with DN was 713.1 (5th to 95th percentile: 546.2-930.6), ESRD was 231.0 (5th to 95th percentile: 176.6-296.2). Under the scenario of the immediate change of the treatment, the results showed that the number of patients with DN in 2015 was 418.9 (5th percentile; 345.4; 95th percentile; 506.1) and with ESRD was 133.4 (5th percentile; 109.0; 95th percentile; 163.8). CONCLUSIONS The results of the projection showed a gradual increase in the number of patients with DMN and ESRD. Examination of three possible scenarios showed that the programme of dissemination of intensive insulin therapy prevented the progression of diabetic renal disease.