TITLE

Continued Reduction in the Prevalence of Retinopathy in Adolescents With Type 1 Diabetes

AUTHOR(S)
DOWNIE, ELIZABETH; CRAIG, MARIA E.; HING, STEPHEN; CUSUMANO, JANINE; CHAN, ALBERT K. F.; DONAGHUE, KIM C.
PUB. DATE
November 2011
SOURCE
Diabetes Care;Nov2011, Vol. 34 Issue 11, p2368
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE--To examine trends in microvascular complications in adolescents with type 1 diabetes between 1990 and 2009 in Sydney, Australia. RESEARCH DESIGN AND METHODS--We used analysis of complications in 1,604 adolescents (54% female, aged 12--20 years, median duration 8.6 years), stratified by four time periods using Generalized Estimation Equations as follows: T1 (1990--1994), T2 (1995--1999), T3 (2000--2004), and T4 (2005--2009). Early retinopathy was detected using seven-field fundal photography, albumin excretion rate (AER) using timed overnight urine collections, and albumin-to-creatinine ratio (ACR) and peripheral nerve function using thermal and vibration threshold. RESULTS--Retinopathy declined (53, 38, 23, and 12%; P < 0.001), as did borderline elevation of AER/ACR (45, 30, 26, and 30%; P < 0.001) and microalbuminuria (8, 4, 3, and 3%; P = 0.006). Multiple daily injections (MDI)/continuous subcutaneous insulin infusion (CSII) use increased (17, 54, 75, and 88%; P , 0.001), median HbA1c decreased (9.1, 8.9, 8.5, and 8.5%; P < 0.001), and severe hypoglycemia was unchanged (6, 8, 10, and 7%; P = 0.272). Retinopathy was associated with diabetes duration (odds ratio [OR] 1.12 [95% CI 1.08--1.17]), age (1.13 [1.06--1.20]), HbA1c (1.16 [1.08--1.25]), systolic blood pressure (BP) SDS (1.31 [1.16--1.48]), socioeconomic disadvantage (1.42 [1.04--1.95]), and 1 to 2 injections per day (vs. MDI/CSII; 1.35 [1.05--1.73]); borderline AER/ACR with male sex (1.32 [1.02--1.70]), age (1.19 [1.12-- 1.26]), HbA1c (1.18 [1.08--1.29]), weight SDS (1.31 [1.21--1.53]), insulin dose per kilograms (1.64 [1.13--2.39]), 1 to 2 injections per day (1.41 [1.08--1.84]), and socioeconomic disadvantage (1.68 [1.23--2.31]); andmicroalbuminuria with age (1.14 [1.01--1.29]), HbA1c (1.20 [1.05-- 1.37]), diastolic BP SDS (1.76 [1.26--2.46]), and 1 to 2 injections per day (1.95 [1.11--3.41]). CONCLUSIONS--The decline in retinopathy supports contemporary guidelines that recommend lower glycemic targets and use of MDI/CSII in children and adolescents with type 1 diabetes.
ACCESSION #
67184691

 

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