Risk of Microvascular Complications and Macrovascular Risk Factors in Early-Onset Type 1 Diabetes after at Least 10 Years Duration: An Analysis of Three Population-Based Cross-Sectional Surveys in Germany between 2009 and 2016.

Thaddäus Tönnies,Rhuphine Yossa,Oliver Kuss,Anna Stahl-Pehe,Reinhard W Holl,Katty Castillo,Christina Baechle,Lena M E Lindner,Joachim Rosenbauer

doi:10.1155/2018/7806980

Thaddäus Tönnies, Rhuphine Yossa + Show 7 more

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https://doi.org/10.1155/2018/7806980

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Abstract

Aims To estimate the risk of microvascular complications and macrovascular risk factors among persons with early-onset (diagnosed at ages 0 to <5 years) and long-duration type 1 diabetes and determine temporal trends and associations with potential predictors. Methods We conducted three population-based cross-sectional surveys in Germany (N = 1789) to obtain information on exposures and five outcomes (retinopathy, nephropathy, dyslipidemia, hypertension, and a composite endpoint combining all four outcomes). For each outcome, log-binomial spline regression was applied to estimate the risk and dose-response relationship with diabetes duration and exposures. Results The risk for microvascular complications increased after 14 years since diabetes diagnosis whereas dyslipidemia and hypertension were already prevalent at 10 years. The 15-year risk (95% confidence interval) of the composite endpoint for female and male patients was 22.9% (18.8%–27.9%) and 19.2% (15.5%–23.8%), respectively. Temporal trends suggested a decreasing risk between 2009 and 2016. Glycemic control, lifestyle-related factors, and SES, but not health care-related factors, were associated with the risk of the composite endpoint. Conclusions In early-onset type 1 diabetes, there exists a considerable risk of complications and comorbidities already in young ages. Future research should focus on prevention of diabetic complications in young patients and clarification of pathways of the associations found.

Highlights

During the past decades, many advances in routine therapy of type 1 diabetes have been achieved, for example, use of insulin pumps, glucose sensors, insulin analogues, or intensified diabetes education and psychosocial support [1]
The risk for microvascular complications increased after 14 years since diabetes diagnosis whereas dyslipidemia and hypertension were already prevalent at 10 years
In early-onset type 1 diabetes, there exists a considerable risk of complications and comorbidities already in young ages

Summary

Introduction

Many advances in routine therapy of type 1 diabetes have been achieved, for example, use of insulin pumps, glucose sensors, insulin analogues, or intensified diabetes education and psychosocial support [1]. Microvascular complications such as diabetic retinopathy (DR). DR with pathologic changes of retinal vessels is the most frequent microvascular complication and may lead to blindness in advanced stages [4]. According to Kaplan–Meier analysis, the cumulative proportion of any DR after 40 years of diabetes duration was estimated at 84% [5]. The crude risk of micro- and macroalbuminuria or end-stage renal disease is estimated with almost 25% and 9%, respectively, after 40 years of diabetes duration [8]

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