Protection From Retinopathy and Other Complications in Patients With Type 1 Diabetes of Extreme Duration

Sun, Jennifer K.; Keenan, Hillary A.; Cavallerano, Jerry D.; Asztalos, Bela F.; Schaefer, Ernst J.; Sell, David R.; Strauch, Christopher M.; Monnier, Vincent M.; Doria, Alessandro; Aiello, Lloyd Paul; King, George L.

doi:10.2337/dc10-1675

Cited by 228 publications

(206 citation statements)

References 24 publications

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“…It has been suggested that circulating and endothelial progenitor cells are involved in protection from cardiovascular complications and nephropathy 23. It was also shown that certain advanced glycation endproducts were inversely associated with proliferative diabetic retinopathy in long‐term survivors, as opposed to previous studies that showed strong associations between advanced glycation endproducts and diabetes complications 18. Thus, long‐term survivors of diabetes appear to develop a compensatory mechanism against the hazardous effects of advanced glycation endproducts, but the exact dynamic has yet to be discovered 24.…”

Section: Discussionmentioning

confidence: 97%

Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10‐year follow‐up

et al. 2016

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AimsTo describe factors associated with prevalence or absence of microvascular and macrovascular complications in people with Type 1 diabetes of very long duration and to investigate the risk factors associated with the incidence of such complications.MethodsWe included individuals with Type 1 diabetes who had been entered in the Swedish National Diabetes Register between 2002 and 2004 (n = 18 450). First, risk factor distribution in people with diabetes duration of ≥ 50 years was compared between people with and without complications. Second, the incidence of complications during a 10‐year follow‐up period was studied in all individuals who had no complications at baseline.ResultsAmong people with a diabetes duration of ≥ 50 years (n = 1023), 453 (44%) had macrovascular disease, 534 (52%) had microvascular disease and 319 (31%) did not have either of the diagnoses. Factors that differed significantly between people with and without macrovascular disease were gender, age, HbA1c, BMI, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, albuminuria, antihypertensive medication and lipid‐lowering medication. The same factors differed significantly between people with and without microvascular disease, with the exception of gender and HDL cholesterol. During the follow‐up period, 6.1% of the study cohort were diagnosed with macrovascular disease and 19.6% with microvascular disease. Incidence of macrovascular disease was significantly associated with HbA1c levels. Hazard ratios decreased with longer diabetes duration.ConclusionsPeople with Type 1 diabetes who have survived ≥ 50 years without complications are significantly younger, and have significantly lower HbA1c levels, BMI and triglyceride levels than survivors with complications. HbA1c level is a predictor of macrovascular disease, independently of diabetes duration.

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Section: Discussionmentioning

confidence: 97%

Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10‐year follow‐up

et al. 2016

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“…In particular, we found a major confounding effect by obesity, but not HbA 1c , and we found no strong positive associations between plasma pentosidine and incident cardiovascular events. Besides their role in CVD, AGEs have been linked to development of microvascular complications of diabetes (1), but interestingly, some plasma AGEs have been linked to higher, while other have been linked to lower risk of microvascular complications (38). As the associations between plasma AGEs and microvascular complications in T2DM are largely unknown, this should be addressed in a future study.…”

Section: Discussionmentioning

confidence: 99%

Plasma Advanced Glycation End Products Are Associated With Incident Cardiovascular Events in Individuals With Type 2 Diabetes: A Case-Cohort Study With a Median Follow-up of 10 Years (EPIC-NL)

et al. 2014

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Experimental data suggest a role for advanced glycation end products (AGEs) in cardiovascular disease (CVD), particularly in type 2 diabetes (T2DM). However, epidemiological evidence of an association between high plasma AGEs and increased cardiovascular risk remains inconclusive. Therefore, in a case-cohort study comprising 134 cardiovascular case subjects and a random subcohort of 218 individuals (including 65 cardiovascular case subjects), all with T2DM and nested in the European Prospective Investigation into Cancer and Nutrition in the Netherlands (EPIC-NL) study, plasma levels of protein-bound Nε-(carboxymethyl)lysine, Nε-(carboxyethyl)lysine, and pentosidine were measured with liquid chromatography. AGEs were loge-transformed, combined in a z-score, and the association with incident cardiovascular events was analyzed with Cox proportional hazard regression, adapted for case-cohort design (Prentice method). After multivariable adjustment (sex, age, cohort status, diabetes duration, total cholesterol to HDL-cholesterol ratio, smoking, systolic blood pressure, BMI, blood pressure–, cholesterol- and glucose-lowering treatment, prior cardiovascular events, and triglycerides), higher plasma AGE z-scores were associated with higher risk of incident cardiovascular events in individuals without prior cardiovascular events (hazard ratio 1.31 [95% CI: 1.06–1.61]). A similar trend was observed in individuals with prior cardiovascular events (1.37 [0.63–2.98]). In conclusion, high plasma AGEs were associated with incident cardiovascular events in individuals with T2DM. These results underline the potential importance of AGEs in development of CVD.

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“…Approximately 50% of these patients have PDR, as might be expected given their long duration of diabetes. However, a substantial proportion (nearly 40%) of the patients, all of whom were diagnosed with diabetes decades before strict glycemic control was standard practice, surprisingly still have no or mild DR (111). In contrast to other large studies in groups with shorter-duration diabetes, DR severity has not been associated with current or longitudinal HbA1c values in this cohort, which suggests the presence of endogenous protective factors in those individuals who have not progressed to advanced diabetic complications, including retinopathy.…”

Section: Future Directionsmentioning

confidence: 99%

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

Duh¹,

Sun²,

Stitt³

2017

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Protection From Retinopathy and Other Complications in Patients With Type 1 Diabetes of Extreme Duration

Cited by 228 publications

References 24 publications

Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10‐year follow‐up

Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10‐year follow‐up

Plasma Advanced Glycation End Products Are Associated With Incident Cardiovascular Events in Individuals With Type 2 Diabetes: A Case-Cohort Study With a Median Follow-up of 10 Years (EPIC-NL)

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

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