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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.
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Keywords
Journal Title the medical journal of australia
Publication Year Start




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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