HbA1c levels in children with type 1 diabetes and correlation to diabetic retinopathy

2018 ◽  
Vol 31 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Rebecka Andreasson ◽  
Charlotte Ekelund ◽  
Mona Landin-Olsson ◽  
Charlotta Nilsson
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycosylated Hemoglobin ◽  
Acute Onset ◽  
Diabetes Diagnosis ◽  
Adequate Treatment ◽  
The Mean ◽  
Hba1c Levels

AbstractBackground:Type 1 diabetes mellitus (T1D) is a metabolic disease causing hyperglycemia due to β-cell destruction. Despite adequate treatment, complications such as diabetic retinopathy (DR) are common. The first aim was to investigate if acute onset of type 1 diabetes differed between those who had developed retinopathy and who had not after 15 years from diagnosis. The second aim was to investigate if mean glycosylated hemoglobin (HbA1c) levels affect the time to development of DR.Methods:The medical records of all children and adolescents diagnosed with type 1 diabetes during 1993–2001 in our area in Sweden were studied retrospectively and the mean HbA1ceach year until the development of retinopathy was investigated. In total 72 patients were included and the follow-up time was between 15 and 23 years. Gender, p-glucose, age and HbA1cat diagnosis were analyzed for possible correlations to years to retinopathy.Results:HbA1cwas significantly higher among those who had developed DR after 15 years from diagnosis, 98±9.2 (n=25) vs. 86±9.2 (n=46; p=0.025). A negative correlation was found between age at diagnosis and years to DR (rs=−0.376; p=0.026). Mean HbA1clevels at years 6–10 after diabetes diagnosis correlated significantly (rs=−0.354, p=0.037) to years until retinopathy. Mean HbA1clevels at years 1–15 after diabetes diagnosis were significantly higher at years 2–3 and years 5–8 for those who had developed retinopathy after 15 years from diagnosis.Conclusions:Higher HbA1clevels shortened the time to development of retinopathy. It is therefore important to keep HbA1cas close to normal as possible.

scholarly journals Continuous subcutaneous insulin infusion alters microRNA expression and glycaemic variability in children with type 1 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emma S. Scott ◽  
Andrzej S. Januszewski ◽  
Luke M. Carroll ◽  
Gregory R. Fulcher ◽  
Mugdha V. Joglekar ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Diabetes Diagnosis ◽  
Subcutaneous Insulin ◽  
Glycaemic Variability ◽  
Altered Expression ◽  
C Peptide

AbstractTo determine whether continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) therapy from near-diagnosis of type 1 diabetes is associated with reduced glycaemic variability (GV) and altered microRNA (miRNAs) expression. Adolescents (74% male) within 3-months of diabetes diagnosis (n = 27) were randomized to CSII (n = 12) or MDI. HbA1c, 1-5-Anhydroglucitol (1,5-AG), high sensitivity C-peptide and a custom TaqMan qPCR panel of 52 miRNAs were measured at baseline and follow-up (median (LQ-UQ); 535 (519–563) days). There were no significant differences between groups in baseline or follow-up HbA1c or C-peptide, nor baseline miRNAs. Mean ± SD 1,5-AG improved with CSII vs. MDI (3.1 ± 4.1 vs. − 2.2 ± − 7.0 mg/ml respectively, P = 0.029). On follow-up 11 miRNAs associated with diabetes vascular complications had altered expression in CSII-users. Early CSII vs. MDI use is associated with lower GV and less adverse vascular-related miRNAs. Relationships with future complications are of interest.

scholarly journals Bariatric surgery in patients with type 1 diabetes: special considerations are warranted

2019 ◽  
Vol 10 ◽  
pp. 204201881882220 ◽  
Author(s):  
Zohar Landau ◽  
Galit Kowen-Sandbank ◽  
Daniela Jakubowicz ◽  
Asnat Raziel ◽  
Nasser Sakran ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Glucose Control ◽  
Healthcare Services ◽  
Short And Long Term ◽  
The Mean

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. Results: Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( p = 0.09). Conclusions: Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

scholarly journals Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018094 ◽  
Author(s):  
Carine Sousa Andrade ◽  
Guilherme Sousa Ribeiro ◽  
Carlos Antonio Souza Teles Santos ◽  
Raimundo Celestino Silva Neves ◽  
Edson Duarte Moreira
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Hba1c Level ◽  
Glycated Haemoglobin ◽  
Poor Adherence ◽  
Adherence To Diet ◽  
The Mean ◽  
Lower Education ◽  
Hba1c Levels

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.

scholarly journals A 20-year prospective follow-up study to evaluate the development of retinopathy and nephropathy after the onset of type 1 diabetes mellitus: Contribution of glycemic control and metabolic memory

2017 ◽  
Vol 89 (10) ◽  
pp. 17-21 ◽  
Author(s):  
L L Bolotskaya ◽  
E G Bessmertnaya ◽  
M V Shestakova ◽  
M Sh Shamkhalova ◽  
L V Nikankina ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Microvascular Complications ◽  
Metabolic Memory ◽  
Follow Up Study ◽  
Study Results ◽  
The Mean

Aim. To assess the time course of changes in the level of glycated hemoglobin (HbA1c) for 20 years after the onset of type 1 diabetes mellitus (T1DM) and to compare its correlation with the development of microvascular complications, such as diabetic retinopathy (DR) and diabetic nephropathy (DN). Subjects and methods. A total of 187 children with new-onset T1DM were registered in Moscow in 1994. During the 20-year follow-up study, these patients underwent regular check-ups at the Endocrinology Research Center, Ministry of Health of the Russian Federation, which included assessment of physical data, HbA1c 2-4 times a year, biochemical blood and albuminuria tests (once per year), and ophthalmologic examination (twice a year). A total of 155 people fully completed the 20-years follow-up study. Results. During the 20-year follow-up period after the onset of T1DM, 86 of the 155 patients developed microvascular complications: DR and DN in 86 (55.5%) and 24 (15.5%) cases, respectively; while DR concurrent with DN were noted in 20 patients. By the time of their last visit, 69 (44.5%) patients had no evidence suggesting the presence of microvascular complications. The level of HbA1c at the onset of the disease in patients who later developed the complications was higher than in those without complications (10.2±0.6 and 8.5±0.2%, respectively (p = 0.003). The statistically significant differences in HbA1c levels between the groups persisted during subsequent 15 years of follow-up, averaging 9.2±1.5, 9.7±0.9, and 8.1±0.7% after 5, 10, and 15 years, respectively, in the complication group and 7.1±0.3, 8.1±0.4, and 7.2±0.2% in the non-complication group (p < 0.01). Over the last 5 years of the follow-up, the mean HbA1c level between the groups was not significantly different, which at the end of the 20-year follow-up period was 7.8±0.3 and 7.4±0.6%, respectively (p > 0.05). The mean duration of T1DM, in which DR developed, was 9.6±6.2, 11.0±2.0, and 13.6±4.6 years for the non-proliferative, pre-proliferative, and proliferative stages, respectively. That of T1DM, in which DN developed, was 11.8±0.6 years for microalbuminuria and 16.1±1.3 years for macroalbuminuria. Conclusion. The 20-year clinical follow-up of patients who had fallen ill with T1DM in childhood showed that diabetic microangiopathies developed with the long-term preservation of poor blood glucose control (BGC) starting at the onset of the disease. At the same time, the complications progressed to more severe stages, despite a clear trend toward better BGC. This may be suggestive of the negative metabolic memory phenomenon, which necessitates stable BGC, starting at the onset of the disease, for the prevention of microvascular complications.

scholarly journals Comment on Pongrac Barlovic et al. The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care 2018;41:2487–2494

Diabetes Care ◽  
2019 ◽  
Vol 42 (3) ◽  
pp. e48-e48 ◽  
Author(s):  
Marion Camoin ◽  
Marie-Noelle Delyfer ◽  
Jean-François Korobelnik ◽  
Kamel Mohammedi ◽  
Laurence Blanco ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Care ◽  
Cardiovascular Outcomes

scholarly journals Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes

2019 ◽  
Vol 57 (5) ◽  
pp. 527-534 ◽  
Author(s):  
Heidi Tikkanen-Dolenc ◽  
◽  
Johan Wadén ◽  
Carol Forsblom ◽  
Valma Harjutsalo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Laser Treatment ◽  
Lower Incidence ◽  
Cox Regression ◽  
Age At Onset ◽  
Self Report

Abstract Aims The aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes. Methods Prospective observational analysis as part of the Finnish diabetic nephropathy (FinnDiane) Study with a mean follow-up time of 10.7 years was performed. A total of 1612 individuals with type 1 diabetes were recruited, and LTPA was assessed at baseline using a validated self-report questionnaire. Severe diabetic retinopathy was defined as the initiation of laser treatment due to severe nonproliferative, proliferative retinopathy or diabetic maculopathy (identified from the Care Register for Health Care). Results A total of 261 patients received laser treatment during the follow-up. Higher frequency of LTPA was associated with a lower incidence of severe diabetic retinopathy (p = 0.024), a finding that remained significant after adjustment for gender, duration, age at onset of diabetes, kidney function, BMI, triglycerides and systolic blood pressure. However, when HbA1c and smoking were added to the Cox regression model the association was no more significant. Conclusions Frequent LTPA is associated with a lower incidence of severe diabetic retinopathy during the follow-up. The total amount or the other components of LTPA (intensity or duration of a single session) were not associated with severe diabetic retinopathy.

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

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Luis Forga ◽  
María José Goñi ◽  
Berta Ibáñez ◽  
Koldo Cambra ◽  
Marta García-Mouriz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Diastolic Blood Pressure ◽  
Hdl Cholesterol ◽  
Time Dependent

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.

scholarly journals Rate of β-Cell Destruction in Type 1 Diabetes Influences the Development of Diabetic Retinopathy: Protective Effect of Residual β-Cell Function for More Than 10 Years

2008 ◽  
Vol 93 (12) ◽  
pp. 4759-4766 ◽  
Author(s):  
Koji Nakanishi ◽  
Chizuru Watanabe
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Cell Function ◽  
Glycosylated Hemoglobin ◽  
Β Cell ◽  
Historical Cohort ◽  
Cell Destruction ◽  
Β Cell Function ◽  
Onset Of Diabetes

Context: Although residual β-cell function delays the onset and progression of diabetic retinopathy in patients with type 1 diabetes, the rate of β-cell destruction is variable. Objective: The aim of the study was to clarify the influence of the rate of β-cell destruction on the development and progression of diabetic retinopathy in type 1 diabetes. Design: We performed a historical cohort study regarding residual β-cell function and retinopathy. Setting: The study was conducted in the outpatient clinic of a general hospital. Patients: A total of 254 patients with type 1 diabetes participated. Main Outcome Measures: Serum C-peptide and fundus findings were evaluated longitudinally. Results: The cumulative incidence of mild nonproliferative diabetic retinopathy was higher in the patients without detectable β-cell function than in those with residual β-cell function at 20, 15, and 10 yr after the onset of diabetes (P = 0.013, P = 0.006, and P = 0.048, respectively), but not at 5 yr after the onset (P = 0.84). There were higher mean glycosylated hemoglobin values during the entire follow-up period in the patients without detectable β-cell function at 20 and 15 yr after the onset of diabetes (P = 0.030 and P = 0.042, respectively). Positivity for HLA-A24 and -DQA1*03, as well as the acute onset of diabetes, was associated with early β-cell loss and also with early development of diabetic retinopathy. Cox proportional hazards analysis showed that undetectable β-cell function at 20, 15, or 10 yr after the onset of diabetes was an independent risk factor for the development of diabetic retinopathy. Conclusions: Undetectable β-cell function within 10 yr of the onset of type 1 diabetes is associated with the earlier occurrence of diabetic retinopathy.

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