Abstract
BackgroundPoor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up.MethodsThis is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women’s and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c <8%). Retinal photography was taken at diabetes annual screening and images were graded by trained graders using a semi-automated computer-based program (Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters.ResultsThere was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: −0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control.ConclusionsOur findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year’s poor glycemic control. Such morphological abnormalities may lead to future development of microvascular complications among T1D pediatric patients with poor glycemic control.
Highlights
Poor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation
Type 1 Diabetes (T1D) is a chronic disease characterized by elevated blood glucose which results from lack of endogenous insulin subsequent to autoimmune destruction of pancreatic beta cells [1]
As poor glycemic control may cause endothelial dysfunction in vivo, and can be reflected in real-time retinal microvascular changes, we investigated the longitudinal association between glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a oneyear follow-up
Summary
Poor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. In several crosssectional population-based studies, retinal arteriolar and venular widening, increased retinal arteriolar tortuosity and enlarged retinal arteriolar branching angle were associated with increased concentrations of fasting plasma glucose (FPG) and glycated haemoglobin (HbA1C), as well as a longer duration of T1D both in children and adults [5, 6]. It is unclear whether such changes are already evident after a short period of poor diabetes control in children with T1D
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