Abstract
Objective: To evaluate the association between insulin-dose adjusted A1C (IDAA1c) and microvascular complications (MC) and hypoglycemia in a representative Brazilian population of Type 1 diabetes mellitus (T1DM) patients.Research Design and Methods: This was a cross-sectional study based on a previous study, “Microvascular Complications in Type 1 Diabetes: a comparative analysis of patients treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy (CT)”. The 168 patients in that study (144 from CT plus 24 from AHST) were re-subdivided into two groups, according to their IDAA1c values (30 patients had IDAA1c ≤ 9; 138 had IDAA1c > 9). Then, the prevalence of MC (diabetic renal disease, neuropathy, and retinopathy), hypoglycemia (blood glucose <60 mg/dL), and severe hypoglycemic (episode of hypoglycemia that required the assistance of another person to treat) events were compared between the groups. The groups were well-matched on these factors: duration of disease, sex, and age at the time of diagnosis of T1DM.Results: After an average of 8 years after diagnosis, only 6.6% (2/30) of the patients from IDAA1c ≤ 9 group developed any MC, whereas 21.0% (29/138) from the IDAA1c > 9 group had at least one complication (p = 0.044). Regarding hypoglycemic events, the proportion of individuals who reported at least 1 episode of hypoglycemia in the last month was 43.3 and 64.7% from the IDAA1c ≤ 9 and IDAA1c > 9 groups, respectively (p = 0.030). Regarding severe hypoglycemia, the proportion of patients presenting at least one episode in the last month and the rate of episode/patient/month were similar between groups (6.7 vs. 13.2%; p = 0.535; and 0.1/patient/month vs. 0.25/patient/month; p = 0.321).Conclusion: In a representative Brazilian population of T1DM patients, those with IDAA1c ≤ 9 presented a lower frequency of MC, as well as fewer episodes of hypoglycemia, in the month prior to the analysis.
Highlights
There is a highly variable rate of decline in β-cell function after diagnosis of type 1 diabetes mellitus (T1DM); many patients retain detectable insulin secretion for years or decades [1]
This study is based on analyses from a previous study, “microvascular complications in T1DM—a comparative analysis of patients treated with autologous non-myeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy.”
The patient data selection was showed on Figure 1
Summary
There is a highly variable rate of decline in β-cell function after diagnosis of type 1 diabetes mellitus (T1DM); many patients retain detectable insulin secretion for years or decades [1]. The assessment of β-cell function can help physicians to evaluate and manage T1DM patients. Direct measurement of endogenous insulin secretion would be the most accurate method of evaluating β-cell function; it presents some limitations such as, low accuracy for very low levels of insulin, inability to differ between insulin and its intermediates, such as proinsulin, inability to differ between endogenous and exogenous insulin, and low reproducibility of the insulin dosage in peripheral blood by virtue of its first-pass hepatic extraction [15]. C-peptide measurements during the mixed-meal tolerance test (MMTT) have been recommended as gold standard to evaluate the degree of β-cell function. The time demand necessary to perform stimulation tests, as well as their usual unavailability, limits their use in clinical practice [28]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
