Predictors of microvascular complications in type 1 diabetic patients at onset: the role of metabolic memory

Eur J Intern Med. 2011 Jun;22(3):266-74. doi: 10.1016/j.ejim.2011.02.009. Epub 2011 Mar 17.

Abstract

Background: Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications.

Methods: 376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up=10.93±4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy.

Results: The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01-3.28; p=0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63-4.83; p<0.001), longer duration of disease (HR 1.98; 95% CI 1.10-3.57; p=0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03-0.92; p=0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34-4.12, p=0.003), as well as at onset (HR 1.85; 95% CI 1.06-3.24; p=0.030).

Conclusions: Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM.

MeSH terms

  • Adolescent
  • Age of Onset
  • Albuminuria / epidemiology
  • Albuminuria / immunology
  • Albuminuria / metabolism
  • Autoantibodies / blood
  • Child
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / metabolism*
  • Diabetic Angiopathies / epidemiology*
  • Diabetic Angiopathies / metabolism*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / immunology
  • Diabetic Nephropathies / metabolism
  • Diabetic Retinopathy / epidemiology
  • Diabetic Retinopathy / immunology
  • Diabetic Retinopathy / metabolism
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Inpatients / statistics & numerical data
  • Insulin-Secreting Cells / immunology
  • Insulin-Secreting Cells / metabolism
  • Longitudinal Studies
  • Male
  • Microcirculation / physiology
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Young Adult

Substances

  • Autoantibodies
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human