The natural history of emerging diabetic retinopathy and microalbuminuria from prepuberty to early adulthood in Type 1 diabetes : a 19-year prospective clinical follow-up study
Tienhaara, Emmi; Falck, Aura A. K.; Pokka, Tytti M.-L.; Tossavainen, Päivi H. (2021-12-17)
Tienhaara, E, Falck, AAK, Pokka, TM-L, Tossavainen, PH. The natural history of emerging diabetic retinopathy and microalbuminuria from prepuberty to early adulthood in Type 1 diabetes: A 19-year prospective clinical follow-up study. Diabet Med. 2022; 39:e14732. doi:10.1111/dme.14732
© 2021 Diabetes UK. This is the peer reviewed version of the following article: Tienhaara, E, Falck, AAK, Pokka, TM-L, Tossavainen, PH. The natural history of emerging diabetic retinopathy and microalbuminuria from prepuberty to early adulthood in Type 1 diabetes: A 19-year prospective clinical follow-up study. Diabet Med. 2022; 39:e14732, which has been published in final form at https://doi.org/10.1111/dme.14732. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
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https://urn.fi/URN:NBN:fi-fe202201199478
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Abstract
Objective: To evaluate the impact of long-term glycaemic control and glycaemic variability on microvascular complications in adolescents and young adults with childhood-onset Type 1 diabetes.
Methods: Twenty-six participants took part in a prospective follow-up study. We used univariate generalised estimating equations (GEE) analysis with first-order autoregressive AR(1) covariance structure for repeated measurements to evaluate the relationship between emerging diabetic retinopathy (DR) and each single explanatory variable, namely age at developmental stages from late prepuberty until early adulthood, duration of diabetes and long-term HbA1c. Thereafter, the simultaneous effect of these three explanatory variables to DR was analysed in a multivariate model.
Results: Twenty-five participants developed DR by early adulthood after a median diabetes duration of 16.2 years (range 6.3–24.0). No participants had DR during prepuberty. Each of the three variables was independently associated with emerging DR: age (OR 1.47, 95% CI to 1.25 to 1.74, p < 0.001) stronger than diabetes duration (OR 1.42, 95% CI 1.23 to 1.63, p < 0.001) and HbA1c (OR 1.02, 95% CI 1.001 to 1.05, p = 0.041) in this population. In the multivariate analysis of these three explanatory variables, only age was associated with DR (adjusted OR 1.52, 95% CI 1.10 to 2.10, p = 0.012).
Conclusions: The emergence of DR during adolescence and early adulthood is not rare and increases with age in patients with deteriorating metabolic control during puberty and thereafter. This underpins the need to prevent deterioration of glycaemic control from taking place during puberty—seen again in this follow-up study—in children with diabetes.
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