Does the long-term clinical course of type I diabetes mellitus differ in patients with prepubertal and pubertal onset? Results of the Berlin Retinopathy Study

Kordonouri, Olga; Danne, Thomas; Enders, I; Weber, Bruno

doi:10.1007/s004310050796

Cited by 33 publications

(27 citation statements)

References 15 publications

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“…Under real-life conditions, there is no glycaemic threshold of HbA 1c between 6.0% (42.1 mmol/mol) and 7.5% (58.5 mmol/mol), as suggested by the DCCT and other studies [20,28]. Thus, our field study supports the guideline that the therapeutic goal should be the best achievable glycaemic target.…”

Section: Discussionsupporting

confidence: 74%

Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Kerner²,

et al. 2011

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Aims/hypothesis The aim of this study was to analyse the risk profile for diabetic retinopathy under real-life conditions in a large cohort of patients with type 1 diabetes. Methods Patients (n=18,891) with childhood, adolescent or adult onset of type 1 diabetes from the prospective German Diabetes Documentation System survey were analysed. A total of 8,784 patients fulfilled the inclusion criterion, which was availability of retinopathy status. Retinopathy grading (any retinopathy, advanced retinopathy), treatment regimens and risk factors were prospectively recorded and tested as covariates by Kaplan-Meier analysis and logistic regression.

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Section: Discussionsupporting

confidence: 74%

Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Kerner²,

et al. 2011

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“…However, in the population at risk, i.e., with a diabetes duration Ͼ15 years, a total of 33 of 4,414 (0.7%) of the patients had developed ESRD due to diabetic nephropathy. The median time of follow-up in this cohort was 21 years (range [15][16][17][18][19][20][21][22][23][24][25][26][27] and the median time from onset of diabetes to ESRD was 20 years (range [15][16][17][18][19][20][21][22][23]. There was no significant difference in median time of follow-up in the three different age-at-onset strata (20.3 [range 15-27], 20.5 [15][16][17][18][19][20][21][22][23][24][25][26][27], 20.4 [15][16][17][18][19][20][21][22][23][24][25][26]…”

Section: Resultsmentioning

confidence: 96%

“…Puberty, in addition to frequently noted deterioration of glycemic control, is characterized by rapid growth and hormonal changes, all factors that could promote the development of chronic diabetes complications (6 -8). Thus, some clinical studies (6,9 -12) but not all (13)(14)(15)(16)(17) suggest that prepubertal diabetes duration may contribute less to the development of microvascular complications than pubertal and postpubertal duration. In addition, there are studies that have suggested that an onset of diabetes in the youngest age-group, age Ͻ5 years, may delay development of chronic diabetes complications such as microalbuminuria and retinopathy (18 -21).…”

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confidence: 99%

Age at Onset of Childhood-Onset Type 1 Diabetes and the Development of End-Stage Renal Disease

et al. 2006

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OBJECTIVE -To analyze the impact of age at onset on the development of end-stage renal disease (ESRD) due to diabetic nephropathy in a nationwide population-based cohort with childhood-onset type 1 diabetes. RESEARCH DESIGN AND METHODS-A record linkage between two nationwide registers, the Swedish Childhood Diabetes Registry, including 12,032 cases with childhoodonset diabetes, and the Swedish Registry for Active Treatment of Uraemia was performed. Log-rank test was used to test differences between cumulative risk curves of developing ESRD due to diabetic nephropathy in three different strata of age at onset (0 -4, 5-9, and 10 -14 years).RESULTS -At a maximum follow-up of 27 years, 33 patients had developed ESRD due to diabetic nephropathy and all had a diabetes duration Ͼ15 years. In total, 4,414 patients had diabetes duration Ͼ15 years, and thus the risk in this cohort to develop ESRD was 33 of 4,414 (0.7%). A significant difference in risk of developing ESRD was found between the youngest (0 -4 years) and the two older (5-9 and 10 -14 years) age-at-onset strata (P ϭ 0.03 and P ϭ 0.001, respectively). A significant difference in the risk of developing ESRD was also found between children with prepubertal (0 -4 and 5-9 years, n ϭ 2,424) and pubertal (10 -14 years, n ϭ 2000) onset of diabetes (P ϭ 0.002). No patient with onset of diabetes before 5 years of age had developed ESRD.CONCLUSIONS -With a median duration of 21 years in this population-based Swedish cohort with childhood-onset diabetes, Ͻ1% of the patients had developed ESRD due to diabetic nephropathy, and a prepubertal onset of diabetes seems to prolong the time to development of ESRD.

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“…However, children who were younger than 5 years at the onset of diabetes experience the same hormonal changes during puberty as those diagnosed with diabetes later in childhood. Additionally, it seems that children with an onset of diabetes at a very young age do not maintain good glycemic control during the pubertal years (38), although there are few longitudinal studies that address this question. It is, however, unclear if hormonal changes of the years before and during puberty occurring simultaneously with the onset of diabetes have an impact on the increased risk of DN later in life.…”

Section: Discussionmentioning

confidence: 99%

Population-Based Assessment of Familial Clustering of Diabetic Nephropathy in Type 1 Diabetes

Harjutsalo¹,

Katoh

Sarti³

et al. 2004

Diabetes

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We determined the magnitude of familial aggregation in the development of diabetic nephropathy (DN) among a population-based cohort of Finnish type 1 diabetic patients. Probands with type 1 diabetes were identified from the nationwide register of all Finnish cases diagnosed during [1965][1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976][1977][1978][1979]. By 1998, there were 537 families with at least two siblings with type 1 diabetes. These 537 probands and their 616 diabetic siblings were followed for a diagnosis of DN until the end of 2001. We identified 323 cases of DN in these families. If the proband had DN, 38% of the siblings also had DN, whereas out of the diabetic siblings of the probands without DN, only 17% had DN (P ‫؍‬ 0.001). Diabetic siblings of the nephropathic probands had a 2.3 times (95% CI 1.4 -2.7) higher risk of DN compared with siblings of probands free of DN. The presence of a severe form of DN in the proband increases the risk threefold for diabetic siblings. Sex, the DN of the proband, the age at the onset of diabetes, and parental type 2 diabetes were significant predictors of DN among diabetic siblings. Although the majority of sibpairs with type 1 diabetes are discordant for DN, its presence in one sibling doubles the risk for the other diabetic siblings. Diabetes 53:2449 -2454, 2004 D iabetic nephropathy (DN) is a primary cause of excess mortality in type 1 diabetic patients (1). It affects about one-third of diabetic patients (2,3), increases the risk of cardiovascular diseases, and may lead to renal failure (1,4). The incidence of DN increases linearly during the first 20 years of the duration of diabetes, but starts to decline thereafter (2,3,5), suggesting that there may be a subset of diabetic patients at an especially high risk for DN. Not all patients with poor glycemic control develop DN during their lifetimes. The observed incidence patterns suggest that genetic factors linked to a predisposition for DN play an important role in the regulating processes that lead to DN.Familial clustering of DN has been previously reported (6 -8). Whether it is a consequence of shared environmental risk factors, genetic factors, or both is unclear. Thus far, no population-based studies on the familial clustering of DN have been published. Previous studies on DN within families have been based on small, hospital-based series. The aim of this study was to analyze the familial aggregation of DN in a large, Finnish, population-based cohort of type 1 diabetic patients and their siblings, avoiding the bias of a family ascertainment. RESEARCH DESIGN AND METHODSWe identified families with two or more siblings with type 1 diabetes and followed the diagnoses of DN in the families until the end of 2001. The original cohort consisted of diabetic subjects diagnosed before the age of 18 years between 1965 and 1979 (n ϭ 5,126), who were included in the nationwide register of Finnish type 1 diabetic patients (9,10). This register was initially based on the Social Insurance Institution Cent...

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Does the long-term clinical course of type I diabetes mellitus differ in patients with prepubertal and pubertal onset? Results of the Berlin Retinopathy Study

Cited by 33 publications

References 15 publications

Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Age at Onset of Childhood-Onset Type 1 Diabetes and the Development of End-Stage Renal Disease

Population-Based Assessment of Familial Clustering of Diabetic Nephropathy in Type 1 Diabetes

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