Abstract
Development of complications in type 1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN, respectively. This tool was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.
Highlights
The hyperglycemic state present in type 1 diabetes is associated with both micro- and macrovascular complications [1,2]
The 1647 type 1 diabetes (T1D) patients were further divided into two groups, subjects who do not have any complications (T1D, n = 1026) and T1D subjects with any complications (T1D_wComp, n = 621)
We developed multivariate models to determine the risks of a microvascular complicationnaïve T1D patient for developing diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), Diabetic retinopathy (DR), and Diabetic nephropathy (DN) based on five variables: patient age, duration of T1D, age at diagnosis of T1D, systolic blood pressure, and HbA1c
Summary
The hyperglycemic state present in type 1 diabetes is associated with both micro- and macrovascular complications [1,2]. Microvascular damage leads to neuropathy, retinopathy, and nephropathy, which are each associated with clinical sequelae. Diabetic peripheral neuropathy (DPN) can lead to poor wound healing, diabetic ulcers, and eventually, amputation [3]. Autonomic neuropathy (AN) can present with cardiac abnormalities, gastroparesis, or erectile dysfunction [4]. Diabetic retinopathy (DR) can lead to blindness [5]. Diabetic nephropathy (DN) can progress to end-stage renal disease, requiring dialysis or renal transplantation [6]
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