Characteristics of Type 1 diabetes of over 50 years duration (the Golden Years Cohort)

Diabet Med. 2003 Oct;20(10):808-11. doi: 10.1046/j.1464-5491.2003.01029.x.

Abstract

Background: Type 1 diabetes mellitus is associated with high levels of premature morbidity and mortality. Prolonged survival is possible, however, and some patients appear to be protected from the long-term complications of this condition.

Methods: Diabetes UK awards medals to patients who have had Type 1 diabetes for 50 years or more. By examining medal-holders, we have established the clinical and biochemical features of a group of 400 subjects (54% male) with Type 1 diabetes of long duration.

Results: Mean age of the subjects was 68.9 years and mean age-at-onset of diabetes 13.7 years. Features of long duration diabetes in this cohort include normal body mass (mean BMI 25.0 kg m-2), low insulin dose (mean 0.52 units kg-2) and greatly elevated HDL-cholesterol (mean 1.84 mmol/l). Mean HbA1c was 7.6% (normal range 3.8-5.0%) and no patient had a normal HbA1c at the time of venesection. As a group, they have long-lived parents and consume moderate amounts of alcohol. Medical contact has often been sporadic. A significant proportion (29%) were taking anti-hypertensive medication. Screening for micro- and macroalbuminuria was positive in 35.7%.

Conclusions: Patients with long-duration (> 50 years) Type 1 diabetes are relatively protected from clinical diabetic nephropathy and large vessel disease; our data are consistent with protection possibly being genetically determined in part via elevated HDL-cholesterol levels. An abnormal urinary albumin/creatinine ratio is common in these patients, despite their low risk of significant renal deterioration; this may have implications for microalbuminuria screening programmes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / complications
  • Cardiovascular Diseases / complications
  • Cataract Extraction
  • Cholesterol, HDL / blood
  • Creatinine / blood
  • Diabetes Mellitus, Type 1* / complications
  • Diabetes Mellitus, Type 1* / genetics
  • Diabetes Mellitus, Type 1* / metabolism
  • Diabetic Retinopathy / complications
  • Diabetic Retinopathy / genetics
  • Diabetic Retinopathy / surgery
  • Female
  • Follow-Up Studies
  • Genotype
  • Glycated Hemoglobin A / analysis
  • HLA-DR Antigens
  • HLA-DRB1 Chains
  • Humans
  • Hypertension / complications
  • Insulin / therapeutic use
  • Laser Therapy
  • Longevity
  • Male
  • Thyroid Diseases / complications
  • Triglycerides / blood

Substances

  • Cholesterol, HDL
  • Glycated Hemoglobin A
  • HLA-DR Antigens
  • HLA-DRB1 Chains
  • Insulin
  • Triglycerides
  • Creatinine