A1 Refereed original research article in a scientific journal
Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study
Authors: White M, Sabin MA, Magnussen CG, O'Connell MA, Colman PG, Cameron F
Publisher: AUSTRALASIAN MED PUBL CO LTD
Publication year: 2017
Journal: Medical Journal of Australia
Journal name in source: MEDICAL JOURNAL OF AUSTRALIA
Journal acronym: MED J AUSTRALIA
Volume: 206
Issue: 9
First page : 398
Last page: 401
Number of pages: 4
ISSN: 0025-729X
DOI: https://doi.org/10.5694/mja16.00712
Abstract
Objectives: To determine the relationship between glycaemic control trajectory and the long term risk of severe complications in people with type 1 diabetes mellitus, as well as the effects of paediatric and adult HbA(1c) levels.Design, setting, participants: Data linkage study of data for adults with childhood-onset type 1 diabetes (diagnosed during 1975-2010) who had transitioned from paediatric diabetes care at the Royal Children's Hospital (Melbourne) to adult diabetes care at the Royal Melbourne Hospital during 1992-2013.Main outcome measures: Severe complications were categorised as severe diabetic retinopathy (SDR), chronic kidney disease, ulceration or amputation, and death. Mean HbA(1c) levels were calculated for the paediatric and adult periods. Four glycaemic control trajectories were defined according to mean paediatric and adult HbA(1c) levels: stable low (paediatric and adult HbA(1c) <= 66mmol/mol); improving (paediatric HbA(1c) > 66mmol/mol, adult HbA(1c) <= 66mmol/mol); worsening (paediatric HbA(1c) <= 66mmol/mol, adult HbA(1c) > 66mmol/mol); and stable high (paediatric and adult HbA(1c) > 66mmol/mol).Results: 503 eligible participants (253men) were identified, 26 (5.2%) of whom had at least one severe complication, including 16 withSDR(3.2%). No-one in the stable low group, but4% of the improving, 1% of the worsening, and 7% of the stable high groups developed SDR. Higher mean paediatric (per 10.9 mmol/mol increase: odds ratio [OR], 2.9; 95% CI, 1.9-4.3; P < 0.01) or adult HbA(1c) levels (OR, 2.1; 95% CI, 1.4-3.1; P < 0.01) were associated with increased risk of SDR, as was longer duration of type 1 diabetes (per additional year: OR, 1.3; 95% CI, 1.2-1.5; P < 0.01).Conclusion: SDR was associated with higher paediatric HbA(1c) levels, independent of glycaemic control during adulthood; it was not documented in patients with a stable low glycaemic control trajectory.
Objectives: To determine the relationship between glycaemic control trajectory and the long term risk of severe complications in people with type 1 diabetes mellitus, as well as the effects of paediatric and adult HbA(1c) levels.Design, setting, participants: Data linkage study of data for adults with childhood-onset type 1 diabetes (diagnosed during 1975-2010) who had transitioned from paediatric diabetes care at the Royal Children's Hospital (Melbourne) to adult diabetes care at the Royal Melbourne Hospital during 1992-2013.Main outcome measures: Severe complications were categorised as severe diabetic retinopathy (SDR), chronic kidney disease, ulceration or amputation, and death. Mean HbA(1c) levels were calculated for the paediatric and adult periods. Four glycaemic control trajectories were defined according to mean paediatric and adult HbA(1c) levels: stable low (paediatric and adult HbA(1c) <= 66mmol/mol); improving (paediatric HbA(1c) > 66mmol/mol, adult HbA(1c) <= 66mmol/mol); worsening (paediatric HbA(1c) <= 66mmol/mol, adult HbA(1c) > 66mmol/mol); and stable high (paediatric and adult HbA(1c) > 66mmol/mol).Results: 503 eligible participants (253men) were identified, 26 (5.2%) of whom had at least one severe complication, including 16 withSDR(3.2%). No-one in the stable low group, but4% of the improving, 1% of the worsening, and 7% of the stable high groups developed SDR. Higher mean paediatric (per 10.9 mmol/mol increase: odds ratio [OR], 2.9; 95% CI, 1.9-4.3; P < 0.01) or adult HbA(1c) levels (OR, 2.1; 95% CI, 1.4-3.1; P < 0.01) were associated with increased risk of SDR, as was longer duration of type 1 diabetes (per additional year: OR, 1.3; 95% CI, 1.2-1.5; P < 0.01).Conclusion: SDR was associated with higher paediatric HbA(1c) levels, independent of glycaemic control during adulthood; it was not documented in patients with a stable low glycaemic control trajectory.
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