Discordant Trends in Microvascular Complications in Adolescents With Type 1 Diabetes From 1990 to 2002

Mohsin, Fauzia; Craig, Maria E.; Cusumano, Janine; Chan, Albert; Hing, Stephen; Lee, Jennifer W.; Silink, Martin; Howard, Neville J.; Donaghue, Kim C.

doi:10.2337/diacare.28.8.1974

Cited by 114 publications

(122 citation statements)

References 48 publications

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“…This result is likely to be due to the low prevalence of microalbuminuria in this cohort (4%) and in other recent reports (12,13). Early elevation of AER precedes the development of microalbuminuria (24); therefore, a possible interpretation of our findings is that augmented collagen deposition within the extracellular matrix of the glomeruli parallels collagen glycation in connective tissues including the plantar aponeurosis.…”

Section: Baselinecontrasting

confidence: 43%

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Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes

et al. 2008

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OBJECTIVE -Direct measurement of collagen glycation requires skin biopsy, which is invasive. We hypothesized that measurement of plantar fascia thickness (PFT) by ultrasound is an alternative index of tissue glycation and a marker of microvascular disease.RESEARCH DESIGN AND METHODS -This was a prospective longitudinal study of microvascular complications in 344 adolescents with type 1 diabetes, whose PFT was assessed by ultrasound at baseline. Retinopathy was assessed by seven-field fundal photography, albumin excretion rate (AER) measured from three consecutive timed overnight urine specimens, autonomic neuropathy by pupillometry and cardiovascular tests, and peripheral neuropathy by vibration and thermal thresholds. Longitudinal analysis was performed using generalized estimating equations with baseline PFT, duration, and A1C as explanatory variables.RESULTS -At first assessment, median (interquartile range) age was 15.1 (13.5-17.2) years and diabetes duration was 8.5 (6.0 -11.5) years. Median follow up was 3.2 (2.1-4.5) years with a median of 4 (2-13) complications assessments per patient. In multivariate analysis, baseline PFT (abnormal in 132 subjects, 38%) predicted subsequent development of retinopathy (odds ratio 2. CONCLUSIONS -PFT is a significant predictor of the subsequent development of complications in type 1 diabetes, suggesting that glycation and oxidation of collagen in soft tissues may be independent risk factors for microvascular complications.

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Section: Baselinecontrasting

confidence: 43%

“…The photographs were graded by the same ophthalmologist (S.H.) according to the Early Treatment Diabetic Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy as described previously (12,13) .…”

Section: Complications Assessmentmentioning

confidence: 99%

Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes

et al. 2008

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“…Detailed characteristics of this cohort have been reported in previous publications (11)(12)(13)(14)(15). Children and adolescents with type 1 diabetes, referred by their physicians, were assessed for complications in our clinics.…”

Section: Research Design Andmentioning

confidence: 99%

Retinal Arteriolar Dilation Predicts Retinopathy in Adolescents With Type 1 Diabetes

et al. 2008

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OBJECTIVE -Alterations in retinal vascular caliber may reflect early subclinical microvascular dysfunction. In this study, we examined the association of retinal vascular caliber to incident retinopathy in young patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -This was a prospective cohort study of 645 initially retinopathy-free type 1 diabetic patients, aged 12-20 years. Participants had seven-field stereoscopic retinal photographs taken of both eyes at baseline and follow-up. Retinal vascular caliber was measured from baseline photographs using a computer-based program following a standardized protocol. Incident retinopathy was graded according to the modified Airlie House classification from follow-up photographs.RESULTS -Over a median follow-up of 2.5 years, 274 participants developed retinopathy (14.8 per 100 person-years). After adjustments for age, sex, diabetes duration, glycemia, mean arterial blood pressure, BMI, and cholesterol levels, larger retinal arteriolar caliber (fourth versus first quartile) was associated with a more than threefold higher risk of retinopathy (hazard rate ratio 3.44 [95% CI 2.08 -5.66]). Each SD increase in retinal arteriolar caliber was associated with a 46% increase in retinopathy risk (1.46 [1.22-1.74]). This association was stronger in female than in male participants. After similar adjustments, retinal venular caliber was not consistently associated with incident retinopathy.CONCLUSIONS -Retinal arteriolar dilatation predicts retinopathy development in young patients with type 1 diabetes. Our data suggest that arteriolar dysfunction may play a critical role in the pathogenesis of early diabetic retinopathy and that computer-based retinal vascular caliber measurements may provide additional prognostic information regarding risk of diabetes microvascular complications.

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“…Such natural course of the disease brings into question the necessity of pharmacological treatment implementation, especially in diabetic children and adolescents. There is no consensus on the frequency of diabetic nephropathy and microalbuminuria, as some reports evidence decreasing prevalence, while others show no improvement despite the intensification of diabetes control and pharmacological therapy [14][15][16][17]. Another important conclusion suggested on the basis of recent studies is that microalbuminuria is reversible even without any intervention.…”

Section: Introductionmentioning

confidence: 99%

Kontrola glikemii i jej zmienność głównymi czynnikami ryzyka mikroalbuminurii u dzieci chorych na cukrzycę typu 1

Nazim¹,

Fendler²,

Starzyk³

2014

Endokrynologia Polska

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Introduction: To assess in a prospective study the course and the predictors of microalbuminuria in children and adolescents with type 1 diabetes. Material and methods: 438 children and adolescents who developed diabetes in the years 1985-2004 were followed for 9.2 ± 3.4 years from the diagnosis. Microalbuminuria was assessed on the basis of timed overnight urine collections performed once per year. Variability of glycated haemoglobin was expressed as a coefficient of variation (%) calculated by dividing standard deviation (adjusted for the number of measurements) by mean of HbA 1c .Results: Microalbuminuria was noted in 99 patients (22.6%) after 8.27 ± 3.3 years of diabetes. In 29 individuals (6.6%), microalbuminuria was persistent. The prevalence of microalbuminuria was not dependent on the period of diabetes diagnosis. During followup, 17 (58.6%) patients with persistent MA reverted to normoalbuminuria. Children without any episodes of microalbuminuria had significantly lower HbA 1c variability (8.44%; 95% CI 7.81-9.08%) than those with one (10.28% 95% CI 9.10-11.47%; p = 0.007).

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Discordant Trends in Microvascular Complications in Adolescents With Type 1 Diabetes From 1990 to 2002

Cited by 114 publications

References 48 publications

Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes

Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes

Retinal Arteriolar Dilation Predicts Retinopathy in Adolescents With Type 1 Diabetes

Kontrola glikemii i jej zmienność głównymi czynnikami ryzyka mikroalbuminurii u dzieci chorych na cukrzycę typu 1

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