Long term risk of severe retinopathy in childhood‐onset type 1 diabetes: a data linkage study

Abstract

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.

Mental health visits and low socio‐economic status in adolescence are associated with complications of Type 1 diabetes in early adulthood: a population‐based cohort study

“…We found a 20% cumulative incidence of laser-or vitrectomy-treated retinopathy by age 36 years; other population-based studies conducted in Norway, Denmark and Sweden report a prevalence of retinopathy in young adults with Type 1 diabetes, ranging from 3% to 55% depending on the definition of retinopathy and the age of the individuals included in the study [24][25][26]. In a single-centre Australian study including 503 participants with childhood-onset Type 1 diabetes a relatively low rate (5.2%) of severe complications, including severe diabetic retinopathy, chronic kidney disease, ulceration or amputation, and death in early adulthood was also reported [27]. We observed a very low rate of dialysis in our cohort (1.8/1000 person-years).…”

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence

“…Certain demographic and socioeconomic factors are also associated with higher HbA1c . Metabolic control during adolescence appears to have a greater association of microvascular complication in later life when compared with subsequent metabolic control in adult years …”

“…61,62 Metabolic control during adolescence appears to have a greater association of microvascular complication in later life when compared with subsequent metabolic control in adult years. 65 The availability of continuous subcutaneous insulin infusion (CSII) pumps and subcutaneous continuous glucose monitoring (CGM)…”

Linking electronic health data in pharmacoepidemiology: Appropriateness and feasibility

“…Data linkage may allow for a more accurate or complete definition of an exposure, outcome, or confounder of interest. Linking EHR (which provides clinical details often absent in other datasets) to administrative claims databases (which contain extensive data on diagnoses and medications, often lacking clinical details) can improve the capture of medication exposure and outcome ascertainment as evidenced by numerous health data linkages across clinical data entities (Table ) …”

“…(2017). Improved outcome ascertainment has been facilitated by linkage in the context of long term retinopathy risks from childhood to adulthood …”