A nationwide cross-sectional study of retinopathy and microalbuminuria in young Norwegian Type 1 (insulin-dependent) diabetic patients

Abstract

A nationwide cohort of Type 1 (insulin-dependent) diabetic patients was studied to determine the prevalence of retinopathy and microalbuminuria and to evaluate the association to various risk factors. Of 600 subjects with mean age of 19.8 years (range 8.0-30.3) and a mean duration of diabetes of 10.5 years (range 6.2-17.3), 371 (60%) volunteered for a clinical examination which included fundus photography, timed overnight urine samples for albumin excretion rate, measurement of arterial blood pressure and determination of HbA1c. Retinopathy was found in 122 of 371 patients (32.8%), in 3 of 41 (7.3%) patients aged less than 13 years. The youngest subject with retinopathy was 9.6 years old. Microalbuminuria was found in 44 of 351 patients (12.5%), in 1 of 41 (2.4%) patients aged less than 13 years. The youngest subject with microalbuminuria was 11.5 years old. Mean HbA1c was 8.6% (normal range 4.5-601%). Patients with retinopathy had significantly higher mean age (p = 0.0001), longer mean duration of diabetes (p = 0.0001), higher mean HbA1c (p = 0.009), and higher mean arterial blood pressure (p = 0.0001) compared to patients without retinopathy. In microalbuminuric patients HbA1c (p = 0.001) and mean arterial blood pressure (p = 0.01) were significantly higher compared to non-microalbuminuric patients, but there was no difference in age or diabetes duration. In a multiple logistic regression model, age, HbA1c, duration of diabetes and mean arterial blood pressure were found to be significantly associated with retinopathy, while HbA1c, mean arterial blood pressure and onset before 13.0 years of age were found to be associated with microalbuminuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Low cumulative incidence of proliferative retinopathy in childhood-onset type 1 diabetes: a 24-year follow-up study

“…In 1989, 600 randomly selected patients among the 1,868 who were alive and still living in Norway were invited to a clinical examination for assessment of diabetic complications as previously reported [15]. Of the 368 subjects who participated in the baseline examination between 1989 and 1990, 355 were eligible for a follow-up examination in the years 2002 to 2003.…”

“…The total risk in the full cohort of participants and non-participants is a weighted average of the Data from non-participants in the examination in 1990 indicated that the mean HbA 1c was 9.5% among nonparticipants compared with 8.9% among participants [15], i.e. a difference of 0.6%.…”

“…2). Mean age at diagnosis of PDR was 27 years (range: 17-41), and mean diabetes duration was 19 years (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Thirty-two patients (10.9%) had no retinopathy at follow-up.…”

“…Numerous studies [8,[11][12][13][14][15][16][17][18][19][20] have described the prevalence and incidence of DR in type 1 diabetes and its relationship to various characteristics. However, only a few population-based studies of retinopathy in subjects with childhood-onset type 1 diabetes are available [13,15,19,20].…”

“…However, only a few population-based studies of retinopathy in subjects with childhood-onset type 1 diabetes are available [13,15,19,20]. Observational studies from dedicated centres [12,13] have argued that the individual risk of developing microvascular complications has declined in recent years as a consequence of improvement in diabetes management.…”