The long-term renal and retinal outcome of childhood-onset Type 1 diabetes

Diabet Med. 2004 Jan;21(1):26-31. doi: 10.1046/j.1464-5491.2003.01062.x.

Abstract

Aims: To quantify the influence of childhood onset on long-term renal and retinal outcome in Type 1 diabetes.

Methods: We used a population-based diabetes register to identify all Type 1 patients diagnosed before age 15 from 1960 to 1982 and resident in a defined catchment area in 1999. Those diagnosed before age 5, aged 5-9 and 10-14 years were compared with a reference group diagnosed at age 21-25 years over the same period.

Results: Compared with adult-onset controls, proteinuria occurred earlier (P = 0.02) and nephropathy outcome was worse (P = 0.008) in childhood-onset diabetes. The risk of developing microalbuminuria was greater in childhood-onset diabetes: odds ratio 2.6 (95% confidence interval 1.4-4.9, P = 0.003). The relative risk of established nephropathy was 3.8 (1.5-9.4, P = 0.005) with childhood onset. The number developing background retinopathy did not differ with age at onset but younger onset patients were more likely to need laser treatment: relative risk 2.1 (1.1-3.8, P = 0.02). This maintained visual outcome which was not significantly different between the various age at onset groups.

Conclusions: Patients with onset of Type 1 diabetes before age 15 have substantially worse renal outcome and require more laser treatment than adult-onset patients. Differences between those with onset before age 5, onset at 5-9 and 10-14 years are small compared with the difference between childhood onset and adult onset. Events in the teenage years therefore appear to have a major adverse effect on the risk of developing long-term microvascular complications.

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Albuminuria / diagnosis
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 1 / urine
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / urine
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / physiopathology
  • Diabetic Retinopathy / urine
  • Female
  • Humans
  • Infant
  • Male
  • Prognosis
  • Proteinuria / diagnosis
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Survival Analysis
  • Time Factors