Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes

Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset.Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables.Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10–14, 15–29, 30–44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure.Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.

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Antithyroid Therapy Improves Glycemic Control in Hyperthyroid Type 1 Diabetes Mellitus Patients

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.1515/rjdnmd-2015-0048 ◽

2015 ◽

Vol 22 (4) ◽

pp. 411-418

Author(s):

Mihaela Vlad ◽

Bogdan Timar ◽

Adrian Vlad ◽

Romulus Timar

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Glucose Control ◽

Hdl Cholesterol

Abstract Background and aims. Thyroid disorders are more frequently met in patients with diabetes mellitus than in general population. Thyroid hormones increase glycemia by several mechanisms, but the effect of antithyroid treatment on glucose control in type 1 diabetes mellitus (T1DM) cases is not well studied. The aim of our work was to analyze the evolution of glycemic control of T1DM patients submitted to specific therapy when hyperthyroidism was diagnosed. Material and method. The study group comprised by 37 patients, 35 women (94.6%) and 2 men (5.4%), known as having T1DM and diagnosed with hyperthyroidism during a 10-years interval. They were treated with antithyroid medication and reassessed after 6 months regarding thyroid function and glycemic control. Results. In the whole group, there was a significant decrease in mean HbA1c level (with 0.41%) and a significant increase in the percentage of patients being in the glycemic target (from 10.8% to 35.1%). The better glycemic control was obtained with a lower mean insulin dose. Patients who became euthyroid had a better evolution regarding glucose control in comparison to those who remained hyperthyroid. Changes in other cardiovascular risk factors were noted: systolic blood pressure decreased; diastolic blood pressure, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides and body weight increased. TSH and HbA1c values were inversely correlated. Conclusions. The therapeutic control of excessive thyroid function significantly contributes to the improvement of glycemic control in patients with T1DM and induces changes in the cardiovascular risk factors profile.

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Prevalence and risk factors for diabetic retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2016-0231 ◽

2016 ◽

Vol 29 (10) ◽

Cited By ~ 4

Author(s):

Stuart Keel ◽

Catherine Itsiopoulos ◽

Konstandina Koklanis ◽

Meri Vukicevic ◽

Fergus Cameron ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Children And Adolescents ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

High Density Lipoproteins ◽

Cross Sectional ◽

Emerging Risk

AbstractBackground:The aim of this study was to investigate the prevalence of, and traditional and emerging risk factors associated with, retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes.Methods:This was a cross-sectional study of 483 children and adolescents with type 1 diabetes. Medical files were audited to collect all relevant clinical data. Diabetic retinopathy was assessed from colour retinal images by an ophthalmologist.Results:Diabetic retinopathy was observed in 11 (2.3%) participants. Logistic regression revealed that the principal components analysis derived risk profile of: higher serum creatinine, older age, higher systolic blood pressures, higher body mass index, abnormal estimated glomerular filtration rate (eGFR) (<59 mL/min), lower high density lipoproteins (HDL) cholesterol, higher serum sodium, longer duration of diabetes and narrower retinal arteriolar calibre was associated with diabetic retinopathy (ExpB=2.60, 95% CI 1.36/4.96, p=0.004).Conclusions:These results support the concept that the pathogenesis of diabetic retinopathy is likely due to the combined influence of various risk factors, many already identified.

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Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment

Endocrine ◽

10.1007/s12020-021-02871-2 ◽

2021 ◽

Author(s):

Paulina Surowiec ◽

Bartłomiej Matejko ◽

Marianna Kopka ◽

Agnieszka Filemonowicz-Skoczek ◽

Tomasz Klupa ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Glycemic Control ◽

De Novo ◽

University Hospital ◽

Specialist Care ◽

Good Glycemic Control ◽

Independent Risk Factors

Abstract Purpose Despite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies. Methods Study included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted. Results The patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09–1.19), HbA1c level (OR 1.41; 95% CI, 1.08–1.84), LDL level (OR 1.79; 95% CI, 1.16–2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16–3.03). Conclusions In this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.

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Bacterial infections as novel risk factors of severe diabetic retinopathy in individuals with type 1 diabetes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316202 ◽

2020 ◽

pp. bjophthalmol-2020-316202

Author(s):

Johan Rasmus Simonsen ◽

Asko Järvinen ◽

Kustaa Hietala ◽

Valma Harjutsalo ◽

Carol Forsblom ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Diabetic Complications ◽

Bacterial Infections ◽

Survival Models ◽

Increased Risk ◽

Treatment Data

Background/AimsDiabetic retinopathy (DR) is associated and shares many risk factors with other diabetic complications, including inflammation. Bacterial infections, potent inducers of inflammation have been associated with the development of diabetic complications apart from DR. Our aim was to investigate the association between bacterial infections and DR.MethodsAdult individuals with type 1 diabetes (n=1043) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. DR was defined as incident severe diabetic retinopathy (SDR), identified as first laser treatment. Data on DR were obtained through fundus photographs and medical records, data on bacterial infections from comprehensive national registries (1 January 1995 to 31 December 2015). Risk factors for DR and serum bacterial lipopolysaccharide (LPS) activity were determined at baseline.ResultsIndividuals with incident SDR (n=413) had a higher mean number of antibiotic purchases/follow-up year compared with individuals without incident SDR (n=630) (0.92 [95% CI 0.82 to 1.02] vs 0.67 [0.62–0.73], p=0.02), as well as higher levels of LPS activity (0.61 [0.58–0.65] vs 0.56 [0.54–0.59] EU/mL, p=0.03). Individuals with on average ≥1 purchase per follow-up year (n=269) had 1.5 times higher cumulative incidence of SDR, compared with individuals with <1 purchase (n=774) per follow-up year (52% vs 35%, p<0.001). In multivariable Cox survival models, the mean number of antibiotic purchases per follow-up year as well as LPS activity were risk factors for SDR after adjusting for static confounders (HR 1.16 [1.05–1.27], p=0.002 and HR 2.77 [1.92–3.99], p<0.001, respectively).ConclusionBacterial infections are associated with an increased risk of incident SDR in type 1 diabetes.

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Poor glycemic control is associated with increased diastolic blood pressure and heart rate in children with Type 1 diabetes

Journal of Diabetes and its Complications ◽

10.1016/s1056-8727(03)00031-x ◽

2004 ◽

Vol 18 (4) ◽

pp. 220-223 ◽

Cited By ~ 10

Author(s):

Michael Y Torchinsky ◽

Ricardo Gomez ◽

Jay Rao ◽

Alfonso Vargas ◽

Donald E Mercante ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Diastolic Blood Pressure ◽

Poor Glycemic Control

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Autoimmune Thyroid Disease is Associated with a Lower Prevalence of Diabetic Retinopathy in Patients with Type 1 Diabetic Mellitus

Medicina ◽

10.3390/medicina56060255 ◽

2020 ◽

Vol 56 (6) ◽

pp. 255

Author(s):

Magdalena Maria Stefanowicz-Rutkowska ◽

Wojciech Matuszewski ◽

Elżbieta Maria Bandurska-Stankiewicz

Keyword(s):

Blood Pressure ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Glycated Hemoglobin ◽

Hdl Cholesterol ◽

Cholesterol Concentration ◽

Control Group ◽

Autoimmune Thyroid Diseases ◽

Autoimmune Thyroid

Background and objectives: The aim of the study was to assess the correlation of autoimmune thyroid diseases (AITD) in patients with diabetes mellitus type 1 (DM1) with the occurrence of diabetic retinopathy (DR). Materials and Methods: The inclusion criteria for the study were: type 1 diabetes diagnosed on the basis of WHO criteria lasting at least a year, presence of AITD for at least a year, and age over 18 years. The control group consisted of patients without diagnosed AITD (DM1noAITD), selected according to age, BMI and DM1 duration. Anthropometric parameters, metabolic risk factors such as glycated hemoglobin (HbA1c), lipids and blood pressure, thyroid status and the presence of DR were assessed. Results: The study involved 200 patients with type 1 diabetes aged 36 ± 12 years, 70 men and 130 women. Patients from the study group (DM1AITD) had significantly lower creatinine concentration, significantly lower systolic blood pressure (SBP), glycated hemoglobin (HbA1c) percentage and triglyceride (TG) concentration, and higher high-density lipoprotein (HDL-cholesterol) concentration than the control group (DM1noAITD). There was a significantly lower chance of non-proliferative diabetic retinopathy (NPDR) among DM1AITD than in the control group. Conclusions: Patients with DM1 and AITD were metabolically better balanced, as evidenced by a significantly lower SBP, percentage of HbA1c and TG, as well as significantly higher HDL-cholesterol in this group. Patients with DM1 and AITD were significantly less likely to have NPDR than the control group.

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322-OR: Risk Factors for Peripheral and Cardiovascular Autonomic Neuropathy in Type 1 Diabetes: Thirty Years of Follow-Up in DCCT/EDIC

Diabetes ◽

10.2337/db19-322-or ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 322-OR

Author(s):

BARBARA BRAFFETT ◽

ROSE GUBITOSI-KLUG ◽

JAMES W. ALBERS ◽

EVA L. FELDMAN ◽

CATHERINE MARTIN ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Autonomic Neuropathy ◽

Cardiovascular Autonomic Neuropathy

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Association between maternal prepregnancy body mass index with offspring cardiometabolic risk factors: analysis of three Brazilian birth cohorts

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174421000179 ◽

2021 ◽

pp. 1-7

Author(s):

Mariane da Silva Dias ◽

Alicia Matijasevich ◽

Ana Maria B. Menezes ◽

Fernando C. Barros ◽

Fernando C. Wehrmeister ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Diastolic Blood Pressure ◽

Cardiometabolic Risk ◽

Hdl Cholesterol ◽

Cardiometabolic Risk Factors ◽

Birth Cohorts ◽

Prepregnancy Bmi ◽

Prepregnancy Body Mass Index

Abstract Evidence suggests that maternal prepregnancy body mass index (BMI) is associated with offspring cardiometabolic risk factors. This study was aimed at assessing the association of maternal prepregnancy BMI with offspring cardiometabolic risk factors in adolescence and adulthood. We also evaluated whether offspring BMI was a mediator in this association. The study included mother–offspring pairs from three Pelotas birth cohorts. Offspring cardiometabolic risk factors were collected in the last follow-up of each cohort [mean age (in years) 30.2, 22.6, 10.9]. Blood pressure was measured using an automatic device, cholesterol by using an enzymatic colorimetric method, and glucose from fingertip blood, using a portable glucose meter. In a pooled analysis of the cohorts, multiple linear regression was used to control for confounding. Mediation analysis was conducted using G-computation formula. In the adjusted model, mean systolic blood pressure of offspring from overweight and obese mothers was on average 1.25 (95% CI: 0.45; 2.05) and 2.13 (95% CI: 0.66; 3.59) mmHg higher than that of offspring from normal-weight mothers; for diastolic blood pressure, the means were 0.80 (95% CI: 0.26; 1.34) and 2.60 (95% CI: 1.62; 3.59) mmHg higher, respectively. Non-HDL cholesterol was positively associated with maternal BMI, whereas blood glucose was not associated. Mediation analyses showed that offspring BMI explained completely the association of maternal prepregnancy BMI with offspring systolic and diastolic blood pressure, and non-HDL cholesterol. Our findings suggest that maternal prepregnancy BMI is positively associated with offspring blood pressure, and blood lipids, and this association is explained by offspring BMI.

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Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

Nutrients ◽

10.3390/nu13082625 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2625

Author(s):

Chiara Garonzi ◽

Gun Forsander ◽

Claudio Maffeis

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Glycemic Control ◽

Children And Adolescents ◽

Cardiovascular Risk Factors ◽

Specific Role ◽

Fat Intake ◽

High Fat

Nutrition therapy is a cornerstone of type 1 diabetes (T1D) management. Glycemic control is affected by diet composition, which can contribute to the development of diabetes complications. However, the specific role of macronutrients is still debated, particularly fat intake. This review aims at assessing the relationship between fat intake and glycemic control, cardiovascular risk factors, inflammation, and microbiota, in children and adolescents with T1D. High fat meals are followed by delayed and prolonged hyperglycemia and higher glycated hemoglobin A1c levels have been frequently reported in individuals with T1D consuming high amounts of fat. High fat intake has also been associated with increased cardiovascular risk, which is higher in people with diabetes than in healthy subjects. Finally, high fat meals lead to postprandial pro-inflammatory responses through different mechanisms, including gut microbiota modifications. Different fatty acids were proposed to have a specific role in metabolic regulation, however, further investigation is still necessary. In conclusion, available evidence suggests that a high fat intake should be avoided by children and adolescents with T1D, who should be encouraged to adhere to a healthy and balanced diet, as suggested by ISPAD and ADA recommendations. This nutritional choice might be beneficial for reducing cardiovascular risk and inflammation.

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