Higher age at onset of type 1 diabetes increases risk of macular oedema

Acta Ophthalmol. 2013 Dec;91(8):709-15. doi: 10.1111/j.1755-3768.2012.02522.x. Epub 2012 Sep 13.

Abstract

Purpose: To investigate whether age at onset of type 1 diabetes is a risk factor for clinically significant macular oedema (CSME).

Methods: A sample of 1354 patients with a mean duration of diabetes 24.6 ± 11.6 years was drawn from the FinnDiane Study population and divided into age at onset groups 0-4 (n = 184), 5-14 (n = 662) and 15-40 years (n = 508). Type 1 diabetes was defined as age at onset ≤40 years, C-peptide negativity and insulin treatment initiated within 1 year of diagnosis. Retinopathy status was assessed from fundus photographs and stereoscopic fundus examinations and graded with the ETDRS scale.

Results: After 30 years of diabetes, the estimated cumulative incidences of CSME were 17% (95% CI 11-26) in age at onset group 0-4 years, 27% (95% CI 23-32) in age at onset group 5-14 years and 34% (95% CI 27-41) in age at onset group 15-40 years (p = 0.002, Gray's test). In a competing risks regression model, adjusted for covariates selected with Bayesian information criteria, age at onset 5-14 years (HR 1.89 [95% CI 1.22-2.91], p = 0.004), and age at onset 15-40 years (HR 3.72 [95% CI 2.35-5.89], p < 0.0001), were significant overall risk factors for CSME (p < 0.0001). Higher ETDRS score (HR 1.04 ([95% CI 1.03-1.05], p < 0.0001), HbA1c (HR 1.12 [95% CI 1.02-1.23], p = 0.016), and total cholesterol (HR 1.19 [95% CI 1.04-1.37], p = 0.013) also increased the risk of CSME.

Conclusions: Higher age at onset of type 1 diabetes is a significant risk factor for macular oedema. This suggests that ageing may modify the risk of retinopathy in type 1 diabetes.

Keywords: ageing; diabetic retinopathy; macular oedema; type 1 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Aging / physiology*
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetic Retinopathy / epidemiology
  • Diabetic Retinopathy / physiopathology
  • Female
  • Finland / epidemiology
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Incidence
  • Infant
  • Macular Edema / epidemiology
  • Macular Edema / physiopathology*
  • Male
  • Risk Factors
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human