Comparisons of Studies on Diabetic Complications Hampered by Differences in GHb Measurements

Kullberg, Carin; Bergström, Anders; Dinesen, Bo; Larsson, Laşse; Little, Randie R.; Goldstein, David E.; Arnqvist, Hans J.

doi:10.2337/diacare.19.7.726

Cited by 56 publications

(40 citation statements)

References 6 publications

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“…It is difficult to compare different levels of HbA 1c since the HbA 1c methods are not yet comparable between countries. Sweden uses the European standard, which, compared with the DCCT standard, is ϳ12% lower (29). The mean weighted HbA 1c level of 7.3% among our patients is the same level as the median HbA 1c level of ϳ10,000 young adult Swedish patients with type 1 diabetes according to the National Diabetes Registry of Sweden (30).…”

Section: Development Of Retinopathymentioning

confidence: 73%

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

et al. 2003

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OBJECTIVE—To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden. RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15–34 years in Sweden. In 1987–1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8–10 years later. The assessment was based on retinal photographs in most cases (86%). RESULTS—Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA1c 8.1 ± 1.5% and 6.8 ± 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA1c (P < 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001). CONCLUSIONS—Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.

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Section: Development Of Retinopathymentioning

confidence: 73%

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

et al. 2003

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“…The HbA 1c method changed during the follow-up period, but we were able to use conversion formulas to compensate for HbA 1c analysis using different methods. As described above, the methods were, even in the early stages, of high precision and standardized against a national standard and also compared with the NGSP values (16,17). This makes it possible to compare our results with the recommendation of HbA 1c targets after the DCCT study.…”

Section: Discussionmentioning

confidence: 98%

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

et al. 2014

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OBJECTIVEHbA 1c is strongly related to the development of diabetes complications, but it is still controversial which HbA 1c level to strive for in the treatment of type 1 diabetes. The aim of the current study was to evaluate HbA 1c , followed from diagnosis, as a predictor of severe microvascular complications and to formulate HbA 1c target levels for treatment. RESEARCH DESIGN AND METHODSA longitudinal observation study followed an unselected population of 451 patients diagnosed with type 1 diabetes during 1983-1987 before the age of 35 years in a region of Southeast Sweden. Retinopathy was evaluated by fundus photography and nephropathy data collected from medical records. HbA 1c was measured starting from diagnosis and during the whole follow-up period of 20-24 years. Long-term weighted mean HbA 1c was then calculated. Complications were analyzed in relation to HbA 1c levels. RESULTSThe incidence of proliferative retinopathy and persistent macroalbuminuria increased sharply and occurred earlier with increasing long-term mean HbA 1c . None of the 451 patients developed proliferative retinopathy or persistent macroalbuminuria below long-term weighted mean HbA 1c 7.6% (60 mmol/mol); 51% of the patients with long-term mean HbA 1c above 9.5% (80 mmol/mol) developed proliferative retinopathy and 23% persistent macroalbuminuria. CONCLUSIONSLong-term weighted mean HbA 1c , measured from diagnosis, is closely associated with the development of severe complications in type 1 diabetes. Keeping HbA 1c below 7.6% (60 mmol/mol) as a treatment target seems to prevent proliferative retinopathy and persistent macroalbuminuria for up to 20 years.

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“…A comparison with other laboratories, including the Diabetes Control and Complications Trial (DCCT), has been reported by our group (17).…”

Section: Biochemical Analysismentioning

confidence: 93%

Use of a Novel Double-Antibody Technique to Describe the Pharmacokinetics of Rapid-Acting Insulin Analogs

Lindström¹,

Hedman²,

Arnqvist

2002

Diabetes Care

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OBJECTIVE -To measure the contribution of bedtime intermediate-acting human insulin on the morning plasma insulin profiles after injection of the rapid-acting insulin analogs lispro and aspart in patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 14 patients with type 1 diabetes, aged 35 Ϯ 13 years (mean Ϯ SD), participated in this single-blind, randomized crossover study. After taking their usual injection of human intermediate-acting insulin the night before, they were given insulin aspart or insulin lispro (10 units) before a standardized breakfast. The contribution of continuing absorption of the human insulin was measured using a monoclonal antibody not cross-reacting with insulin aspart or lispro, whereas the contribution of the analogs was estimated by subtraction after measurement of all plasma free insulin using an antibody cross-reacting equally with human insulin and both analogs.RESULTS -The correlation coefficient of the fasting free insulin concentrations measured with both insulin methods was 0.95. Fasting free insulin was 95 Ϯ 25 pmol/l before administration of insulin aspart, when determined with enzyme-linked immunosorbent assay detecting only human insulin, and 71 Ϯ 20 pmol/l before administration of insulin lispro (NS). Both insulin analogs gave marked peaks of free insulin concentrations, lispro at 40 Ϯ 3 min and aspart at 55 Ϯ 6 min after injection (P ϭ 0.01). The later part of the profiles, from 4.5 to 5.5 h after injection, were similar and showed almost no contribution of the insulin analogs.CONCLUSIONS -The combination of insulin assays that detect human insulin only or both human insulin and analogs provides a new tool for studying insulin pharmacokinetics. Using this technique, we showed that 4.5 h after administration of the rapid-acting insulin analogs lispro and aspart, the free insulin levels are almost only attributable to the intermediateacting insulin given at bedtime. Diabetes Care 25:1049 -1054, 2002T wo rapid-acting insulin analogs are now available for treatment of patients with diabetes. Insulin lispro has an inversion of the amino acids proline and lysine at positions 28 and 29 in the B-chain of the insulin molecule (1), and insulin aspart has a single amino acid substitution in position 28 of the B-chain (2). Lispro has a slightly increased affinity for the IGF-I receptor, but regarding metabolic and mitogenic effects, lispro and aspart are similar to human insulin (3). Both analogs form less stable hexamers than human regular insulin and, owing to this, have a faster absorption, more rapid action, and shorter duration after subcutaneous injection (1,3-13). The short duration of these insulin analogs affects the need for basal insulin substitution.We have recently reported a comparison of the morning insulin profiles of insulin aspart and lispro after subcutaneous injection in patients with type 1 diabetes treated with preprandial insulin injections during the day and human intermediate-acting insulin at bedtime (14). The insulin profiles of these anal...

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Comparisons of Studies on Diabetic Complications Hampered by Differences in GHb Measurements

Abstract: There were large differences in GHb values among laboratories participating in studies of diabetic complications. The present data offer a guide to the comparison of results from the studies and underscores the need for standardization of GHb measurements.

Cited by 56 publications

References 6 publications

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

Use of a Novel Double-Antibody Technique to Describe the Pharmacokinetics of Rapid-Acting Insulin Analogs

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