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

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.

Download Full-text

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

Journal of Diabetes Research ◽

10.1155/2016/9898309 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 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.

Download Full-text

Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up

Diabetes Care ◽

10.2337/dc15-1990 ◽

2016 ◽

Vol 39 (5) ◽

pp. 686-693 ◽

Cited By ~ 238

Author(s):

Keyword(s):

Type 1 Diabetes ◽

Cardiovascular Outcomes ◽

Diabetes Treatment

Download Full-text

Comment on Garofolo et al. Insulin Resistance and Risk of Major Vascular Events and All-Cause Mortality in Type 1 Diabetes: A 10-Year Follow-up Study. Diabetes Care 2020;43:e139–e141

Diabetes Care ◽

10.2337/dc20-2934 ◽

2021 ◽

Vol 44 (4) ◽

pp. e79-e80

Author(s):

José-Miguel González-Clemente ◽

Gemma Llauradó ◽

Lara Albert ◽

Olga Giménez-Palop ◽

Eugenia Berlanga ◽

...

Keyword(s):

Insulin Resistance ◽

Type 1 Diabetes ◽

Diabetes Care ◽

Vascular Events ◽

Follow Up Study ◽

All Cause Mortality

Download Full-text

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.

Download Full-text

Longitudinal Changes in Corneal Cell and Nerve Fiber Morphology in Young Patients with Type 1 Diabetes with and without Diabetic Retinopathy: A 2-Year Follow-up Study

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.18-24516 ◽

2019 ◽

Vol 60 (2) ◽

pp. 830 ◽

Cited By ~ 3

Author(s):

Eszter A. Deák ◽

Eszter Szalai ◽

Noémi Tóth ◽

Rayaz A. Malik ◽

András Berta ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Nerve Fiber ◽

Young Patients ◽

Fiber Morphology ◽

Corneal Cell ◽

Longitudinal Changes ◽

Follow Up Study

Download Full-text

Assessment of diabetic retinopathy in type 1 diabetes in a diabetes care center in South India—Feasibility and awareness improvement study

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_1851_19 ◽

2020 ◽

Vol 68 (13) ◽

pp. 92

Author(s):

Ramachandran Rajalakshmi ◽

CoimbatoreSubramaniam Shanthirani ◽

Amutha Anandakumar ◽

RanjitMohan Anjana ◽

GV S Murthy ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Diabetes Care ◽

South India ◽

Care Center

Download Full-text

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

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0417 ◽

2018 ◽

Vol 31 (4) ◽

pp. 369-374 ◽

Cited By ~ 2

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.

Download Full-text