Characteristics of Type 1 diabetes of over 50 years duration (the Golden Years Cohort)

Abstract

Patients with long-duration (> 50 years) Type 1 diabetes are relatively protected from clinical diabetic nephropathy and large vessel disease; our data are consistent with protection possibly being genetically determined in part via elevated HDL-cholesterol levels. An abnormal urinary albumin/creatinine ratio is common in these patients, despite their low risk of significant renal deterioration; this may have implications for microalbuminuria screening programmes.

Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10‐year follow‐up

“…People with a diabetes duration of ≥ 50 years without previous CVD had significantly higher systolic blood pressure than those with previous CVD in the present study; however, ~84% of people with a history of such complications reported the use of antihypertensive medication. The corresponding proportion of those without previous CVD was ~62%, which is more than twice as high as the figures reported in the Golden Years cohort 9. This is somewhat surprising given that the mean age among people without complications in the present cohort was only 64 years, as opposed to 69 years in the Golden Years study, and is probably attributable to recent changes in risk factor treatment practices.…”

“…A previous cross‐sectional study of 400 people with > 50 years duration of Type 1 diabetes (the Golden Years cohort in the UK) suggested that they were relatively well protected from microvascular and macrovascular disease, possibly as a result of elevated HDL cholesterol levels 9. The present study showed significantly higher levels of HDL cholesterol in corresponding people who did not have a history of CVD at baseline.…”

“…The design of these studies has, however, been mainly cross‐sectional, relying on self‐reported data, and the results are inconsistent. The Golden Years Study reported relatively mediocre glycaemic control among long‐term survivors, whereas the Joslin 50‐year Medalist study found no association between HbA 1c levels and diabetes complications 9, 10.…”

How to survive diabetes

“…Studies of long-term survivors reveal some consistent features [10][11][12][13][14]. For example, a clinical survey of 92 individuals who had survived for more than 40 years found that 30 had no detectable complications, 22 had 'minor' complications (mainly background retinopathy), 16 were blind or visually impaired, two had disabling neuropathy and eight had proteinuria.…”

“…More men died than women, but not when corrected for relative mortality [11,12]. The more recent UK Golden Years study reports data collected by research nurses in the course of home visits, and provides indirect testimony as to the impact of laser therapy, for of the 400 50 year medalists, only 2% were blind [13]. The Joslin Medalist study reported questionnaire data on 326 similar individuals [14], and the two studies are compared in Table 1.…”