Type 1 Diabetes: Complications After 20 Years' Duration
Clinical characteristics are summarized in Table 1. After an average of nearly 20 years' duration, the prevalence of any DR in the whole group of patients was 55% (58 of 105): 40% (43 of 105) had grade 2 DR, 9% (9 of 105) had grade 3 DR, 4% (4 of 105) had grade 4 DR, and 2% (2 of 105) had grade 5 DR (Table 2). Among the more severe grades of DR, the distribution of males and females was not significantly different both in the prepubertal and in the pubertal group. In the more severe grades of DR, the prevalence of overweight (15%) and obese (8%) patients was not different from the group without DR (18 and 5%, respectively). Diabetes duration was longer in the patients with DR than in patients without DR (20.7 ± 4.3 vs. 18.4 ± 3.4 years, P = 0.004), whereas there were no differences between the durations of disease of the patients with mild and those with moderate-to-severe DR. The two patients with grade 5 DR both had 27 years of duration and were pubertal at onset.
The prevalence of DR was higher in the patients who were pubertal at onset than in those who were prepubertal, both for any DR (71 vs. 40%, P = 0.002) and for mild or more severe DR (Pearson χ = 10.6, P = 0.005) (Table 2). These differences were confirmed only in the patients with <20 years' duration (any DR 63 vs. 27%, P = 0.005), not in those with longer duration (any DR 88 vs. 63%, P = NS). The prevalence of overweight, obesity, and hypertension was not significantly different in the prepubertal and pubertal groups (Table 2) and in the various grades of RD. Only three patients were hypertensive, and they all belonged to the pubertal group. Of these patients, one had no DR, one had grade 3, and one had grade 5.
The prevalence of increased UAE in the entire sample was 7% (6 of 86): 2 out of the 45 prepubertal patients, both without DR, and 4 out of the 41 pubertal (Table 2), of whom 2 associated with grade 2, 1 with grade 3, and 1 with grade 5 DR. This difference was not statistically significant. Lifetime HbA1c values of the patients with abnormal UAE were not significantly different from those of the normoalbuminuric patients. None of the patients showing increased UAE were hypertensive, and 2 of them (1 prepubertal and 1 pubertal) reverted to normal after ACE-inhibition therapy.
Lifetime HbA1c values did not differ between prepubertal and pubertal patients in the whole sample or in the patients without DR or with mild DR (Table 3). However, in the small group of patients with moderate-to-severe DR, lifetime HbA1c levels were higher in the prepubertal than in pubertal patients (157.6 ± 5.5 vs. 141.3 ± 6.9%, P < 0.01) (Table 3). None of the above subgroups had different HbA1c values in the first 5 years of disease.
Lifetime levels of HbA1c were higher in the patients with moderate-to-severe DR than in those with mild or no DR in the whole patient sample and among the prepubertal patients, whereas no such difference was observed among the pubertal patients (Table 3 and Fig. 1). No significant differences regarding HbA1c values in the first 5 years of disease were found in any comparison.
(Enlarge Image)
Figure 1.
Distribution of HbA1c values, as percentage above the upper normal reference value, in the prepubertal-onset and pubertal-onset patients, subdivided according to grade of severity of DR.
Results
Clinical characteristics are summarized in Table 1. After an average of nearly 20 years' duration, the prevalence of any DR in the whole group of patients was 55% (58 of 105): 40% (43 of 105) had grade 2 DR, 9% (9 of 105) had grade 3 DR, 4% (4 of 105) had grade 4 DR, and 2% (2 of 105) had grade 5 DR (Table 2). Among the more severe grades of DR, the distribution of males and females was not significantly different both in the prepubertal and in the pubertal group. In the more severe grades of DR, the prevalence of overweight (15%) and obese (8%) patients was not different from the group without DR (18 and 5%, respectively). Diabetes duration was longer in the patients with DR than in patients without DR (20.7 ± 4.3 vs. 18.4 ± 3.4 years, P = 0.004), whereas there were no differences between the durations of disease of the patients with mild and those with moderate-to-severe DR. The two patients with grade 5 DR both had 27 years of duration and were pubertal at onset.
The prevalence of DR was higher in the patients who were pubertal at onset than in those who were prepubertal, both for any DR (71 vs. 40%, P = 0.002) and for mild or more severe DR (Pearson χ = 10.6, P = 0.005) (Table 2). These differences were confirmed only in the patients with <20 years' duration (any DR 63 vs. 27%, P = 0.005), not in those with longer duration (any DR 88 vs. 63%, P = NS). The prevalence of overweight, obesity, and hypertension was not significantly different in the prepubertal and pubertal groups (Table 2) and in the various grades of RD. Only three patients were hypertensive, and they all belonged to the pubertal group. Of these patients, one had no DR, one had grade 3, and one had grade 5.
The prevalence of increased UAE in the entire sample was 7% (6 of 86): 2 out of the 45 prepubertal patients, both without DR, and 4 out of the 41 pubertal (Table 2), of whom 2 associated with grade 2, 1 with grade 3, and 1 with grade 5 DR. This difference was not statistically significant. Lifetime HbA1c values of the patients with abnormal UAE were not significantly different from those of the normoalbuminuric patients. None of the patients showing increased UAE were hypertensive, and 2 of them (1 prepubertal and 1 pubertal) reverted to normal after ACE-inhibition therapy.
Lifetime HbA1c values did not differ between prepubertal and pubertal patients in the whole sample or in the patients without DR or with mild DR (Table 3). However, in the small group of patients with moderate-to-severe DR, lifetime HbA1c levels were higher in the prepubertal than in pubertal patients (157.6 ± 5.5 vs. 141.3 ± 6.9%, P < 0.01) (Table 3). None of the above subgroups had different HbA1c values in the first 5 years of disease.
Lifetime levels of HbA1c were higher in the patients with moderate-to-severe DR than in those with mild or no DR in the whole patient sample and among the prepubertal patients, whereas no such difference was observed among the pubertal patients (Table 3 and Fig. 1). No significant differences regarding HbA1c values in the first 5 years of disease were found in any comparison.
(Enlarge Image)
Figure 1.
Distribution of HbA1c values, as percentage above the upper normal reference value, in the prepubertal-onset and pubertal-onset patients, subdivided according to grade of severity of DR.
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