Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study.
|Abstract||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 HbA1c levels.|
Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study.
A high mean-HbA1c value 3-15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood--a pilot study using two nation-wide population based quality registries.
|Journal Title||the medical journal of australia|
|Publication Year Start||2017-01-01|
PMID- 28490305 OWN - NLM STAT- MEDLINE DA - 20170511 DCOM- 20170517 LR - 20170517 IS - 1326-5377 (Electronic) IS - 0025-729X (Linking) VI - 206 IP - 9 DP - 2017 May 15 TI - Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study. PG - 398-401 AB - 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 HbA1c 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 HbA1c levels were calculated for the paediatric and adult periods. Four glycaemic control trajectories were defined according to mean paediatric and adult HbA1c levels: stable low (paediatric and adult HbA1c </= 66 mmol/mol); improving (paediatric HbA1c > 66 mmol/mol, adult HbA1c </= 66 mmol/mol); worsening (paediatric HbA1c </= 66 mmol/mol, adult HbA1c > 66 mmol/mol); and stable high (paediatric and adult HbA1c > 66 mmol/mol). RESULTS: 503 eligible participants (253 men) were identified, 26 (5.2%) of whom had at least one severe complication, including 16 with SDR (3.2%). No-one in the stable low group, but 4% 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 HbA1c 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 HbA1c levels, independent of glycaemic control during adulthood; it was not documented in patients with a stable low glycaemic control trajectory. FAU - White, Mary AU - White M AD - The Royal Children's Hospital, Melbourne, VIC [email protected] FAU - Sabin, Matthew A AU - Sabin MA AD - The Royal Children's Hospital, Melbourne, VIC. FAU - Magnussen, Costan G AU - Magnussen CG AD - Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS. FAU - O'Connell, Michele A AU - O'Connell MA AD - The Royal Children's Hospital, Melbourne, VIC. FAU - Colman, Peter G AU - Colman PG AD - The Royal Children's Hospital, Melbourne, VIC. FAU - Cameron, Fergus AU - Cameron F AD - The Royal Children's Hospital, Melbourne, VIC. LA - eng PT - Journal Article PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 RN - 0 (Blood Glucose) RN - 0 (Hemoglobin A, Glycosylated) SB - IM MH - Adolescent MH - Adult MH - Blood Glucose/analysis MH - Child MH - Child, Preschool MH - Diabetes Mellitus, Type 1/*complications MH - Diabetic Retinopathy/*epidemiology MH - Female MH - Follow-Up Studies MH - Hemoglobin A, Glycosylated/*analysis MH - Humans MH - Information Storage and Retrieval MH - Kidney Diseases/*epidemiology MH - Logistic Models MH - Male MH - Multivariate Analysis MH - Retrospective Studies MH - Risk Factors MH - Transition to Adult Care MH - Victoria MH - Young Adult EDAT- 2017/05/12 06:00 MHDA- 2017/05/18 06:00 CRDT- 2017/05/12 06:00 PHST- 2016/06/14 [received] PHST- 2016/11/30 [accepted] AID - 10.5694/mja16.00712 [pii] PST - ppublish SO - Med J Aust. 2017 May 15;206(9):398-401.
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