Infant and Toddler Type 1 Diabetes
Complications after 20 years’ duration
- Silvana Salardi, MD1⇓,
- Massimo Porta, MD, PHD2,
- Giulio Maltoni, MD1,
- Flavia Rubbi, MD3,
- Silvia Rovere, MD2,
- Franco Cerutti, MD4,
- Dario Iafusco, MD5,
- Stefano Tumini, MD6,
- Vittoria Cauvin, MD7 and
- the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED)*
- 1Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- 2Diabetic Retinopathy Centre, Department of Internal Medicine, University of Turin, Turin, Italy
- 3Department of Ophthalmology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- 4Department of Pediatrics, University of Turin, Turin, Italy
- 5Department of Pediatrics, Second University of Naples, Naples, Italy
- 6Department of Pediatrics, University of Chieti, Chieti, Italy
- 7Pediatric Unit, S. Chiara Hospital, Trento, Italy
- Corresponding author: Silvana Salardi, .
OBJECTIVE To compare the effect of the prepubertal duration of diabetes on the occurrence of complications in two groups of patients after the same number of years of the disease.
RESEARCH DESIGN AND METHODS This multicenter study enrolled 105 patients aged 16–40.3 years; 53 were prepubertal at diagnosis (aged 0–3) and 52 were pubertal (Tanner stage) and aged 9–14.9. The mean duration of disease was 19.8 and 19.5 years for prepubertal and pubertal patients, respectively. In all patients, retinal photographs were taken and centrally graded. Urinary albumin excretion (UAE; 86 case subjects), blood pressure (BP; 89 case subjects), and lifetime HbA1c (72 case subjects) were also evaluated.
RESULTS The prevalence of diabetic retinopathy (DR) was higher in pubertal than in prepubertal patients, both for any grade DR (71 vs. 40%, P = 0.002) and for mild or more severe DR (P = 0.005). The prevalence of abnormal UAE was not different in the two groups. Hypertension was found only in three patients, all pubertal at diagnosis. In the small group with moderate-to-severe DR, lifetime HbA1c levels, as percentages above the upper normal reference value, were higher (P < 0.01) in prepubertal than in pubertal patients.
CONCLUSIONS If diabetes is diagnosed in infants or toddlers and the prepubertal duration of diabetes is very long, the patients seem to be protected against DR. This protection disappears if lifetime metabolic control is bad. Instead, when onset is at puberty, the DR risk is higher and less dependent on metabolic control and may be influenced by age-related factors, such as BP.
- Received August 8, 2011.
- Accepted December 12, 2011.
- © 2012 by the American Diabetes Association.
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