Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I

Orchard, Trevor J.; Dorman, Janice S.; Maser, Raelene E.; Becker, Dorothy J.; Ellis, Demetrius; LaPorte, Ronald E.; Kuller, Lewis H.; Wolfson, Sidney K.; Drash, Allan L.

doi:10.2337/diacare.13.7.741

Cited by 202 publications

(130 citation statements)

References 14 publications

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“…In contrast in the EURODIAB Type I Complications Study current smoking was associated with albuminuria [31], a finding consistent with most [32±35] but not all [36] other studies.…”

Section: Discussionsupporting

confidence: 81%

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

et al. 2001

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Diabetes accounts for one third or more of all new end stage renal disease in the United States and accounts for at least 16 % of all new patients going onto renal replacement therapy in Europe [1]. The most common cause of end stage renal disease in diabetes is diabetic glomerulosclerosis (nephropathy).Previous studies have shown that hyperglycaemia is an important risk factor for diabetic renal disease [2,3]. More controversy exists on the extent to which systolic blood pressure and lipid disturbances are risk factors for renal disease rather than being a consequence of it. Data on risk factors for renal disease in prospective studies of diabetes are sparse. The Diabetologia (2001) Results. In 959 subjects with Type I (insulin-dependent) diabetes mellitus and 2559 with Type II (noninsulin-dependent) diabetes mellitus, the average follow-up was 8.4 years ( 2.7). By the end of the follow-up period 53 patients in the Type I diabetic group and 134 patients in the Type II diabetic group had developed renal failure (incidence rate 6.3:1000 person years). Increasing age and duration of diabetes were associated with renal failure in Type II and Type I diabetes. In Type II diabetes duration of diabetes was a more important risk factor than age. In both Type I and Type II diabetic retinopathy and proteinuria were strongly associated with renal failure. Systolic blood pressure was associated with renal failure in Type I but not in Type II diabetic patients. ECG abnormalities at baseline, self-reported smoking and cholesterol were not associated with renal failure. Triglycerides were measured in a subset of centres. Among those with Type II, but not Type I diabetes, triglycerides were associated with renal failure independently of systolic blood pressure, proteinuria or retinopathy. In Type II diabetes fasting plasma glucose was associated with renal failure independently of other risk factors. Conclusion/interpretation. We have confirmed the role of proteinuria and retinopathy as markers of renal failure and the importance of hyperglycaemia in renal failure in Type I and Type II diabetes. Plasma triglycerides seem to be an important predictor of renal failure in Type II diabetes. In Type I diabetes systolic blood pressure is an important predictor of renal failure. [Diabetologia (2001)

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“…In contrast in the EURODIAB Type I Complications Study current smoking was associated with albuminuria [31], a finding consistent with most [32±35] but not all [36] other studies.…”

Section: Discussionsupporting

confidence: 81%

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

et al. 2001

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“…Subjects were first seen between 1986 and1988, and were reexamined biennially over a 10-year period. The EDC has been described earlier in detail [17,18]. Briefly, study participants were diagnosed between 1950 and 1980, and seen within 1 year of diagnosis at the Children's Hospital of Pittsburgh (Pennsylvania, USA).…”

Section: The Pittsburgh Epidemiology Of Diabetes Complications Studymentioning

confidence: 99%

The prospective association between adiponectin and coronary artery disease among individuals with type 1 diabetes. The Pittsburgh Epidemiology of Diabetes Complications Study

et al. 2004

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Aims/hypothesis: Recent findings suggest the potential involvement of adiponectin in obesity, diabetes and cardiovascular disease. We assessed the prospective association between adiponectin concentration and coronary artery disease in individuals with type 1 diabetes. Methods: Participants were identified from the Pittsburgh Epidemiology of Diabetes Complications cohort, a prospective follow-up study of childhood-onset type 1 diabetes. At baseline, subjects had a mean age of 28 years, and a mean diabetes duration of 19 years. Cases (deter mined by physician-diagnosed angina, confirmed myocardial infraction, stenosis ≥50%, ischemic ECG or revascularization) were matched to the control subjects with respect to sex, age and diabetes duration. Samples and risk factors for analyses were identified from the earliest exam prior to incidence in cases. Sera and information on all covariates were available for 28 cases and 34 control subjects. Proportional hazards models were constructed including matching variables. Results: Compared with those in men, adiponectin concentrations were elevated in females (p=0.009) and among individuals with macroalbuminuria (p=0.04). In multivariable analyses (adjusting for standard risk factors as well as lipoprotein measurements determined by nuclear magnetic resonance spectroscopy, E-selectin or antioxidants), adiponectin inversely predicted the incidence of coronary artery disease (hazard ratio=0.37 per 1 SD increase, 95% CI 0.19-0.73, p=0.004). Conclusions/interpretation: The results suggest that increased adiponectin concentration is prospectively associated with a lower risk of coronary artery disease type 1 diabetes. The potential of adiponectin determination as a useful marker of, and potential therapeutic target for, coronary artery disease prevention in type 1 diabetes should be further explored.

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“…Recruitment and study methods have been described previously [11,16,17]. Briefly, there were 658 participants in the baseline examination (1986)(1987)(1988).…”

Section: Change Analysismentioning

confidence: 99%

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

et al. 2007

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Aims/hypothesis To complete a comparative analysis of studies that have examined the relationship between glycaemia and cardiovascular disease (CVD)/coronary artery disease (CAD) and perform a prospective analysis of the effect of change in glycosylated Hb level on CAD risk in the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) of childhood-onset type 1 diabetes mellitus (n=469) over 16 years of two yearly follow-up.Methods Measured values for HbA 1 and HbA 1c from the EDC were converted to the DCCT-standard HbA 1c for change analyses and the change in HbA 1c was calculated (final HbA 1c minus baseline HbA 1c ). CAD was defined as EDC-diagnosed angina, myocardial infarction, ischaemia, revascularisation or fatal CAD after medical record review. Results The comparative analysis suggested that glycaemia may have a stronger effect on CAD in patients without, than in those with, albuminuria. In EDC, the change in HbA 1c differed significantly between CAD cases (+0.62± 1.8%) and non-cases (−0.09±1.9%) and was an independent predictor of CAD. Conclusions/interpretation Discrepant study results regarding the relationship of glycaemia with CVD/CAD may, in part, be related to the prevalence of renal disease. Measures of HbA 1c change over time show a stronger association with CAD than baseline values.

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Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I

Cited by 202 publications

References 14 publications

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

The prospective association between adiponectin and coronary artery disease among individuals with type 1 diabetes. The Pittsburgh Epidemiology of Diabetes Complications Study

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

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