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

Role of insulin therapy and glycemic control

  1. Kim C. Donaghue, MBBS, PHD, FRACP1,3
  1. 1Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  2. 2School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4Ophthalmology Department, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  1. Corresponding author: Kim C. Donaghue, kimd{at}chw.edu.au.

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]); and microalbuminuria 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.

  • Received April 18, 2011.
  • Accepted August 17, 2011.

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