Risk of Microvascular Complications and Macrovascular Risk Factors in Early-Onset Type 1 Diabetes after at Least 10 Years Duration: An Analysis of Three Population-Based Cross-Sectional Surveys in Germany between 2009 and 2016

Abstract

Aims To estimate the risk of microvascular complications and macrovascular risk factors among persons with early-onset (diagnosed at ages 0 to <5 years) and long-duration type 1 diabetes and determine temporal trends and associations with potential predictors. Methods We conducted three population-based cross-sectional surveys in Germany (N = 1789) to obtain information on exposures and five outcomes (retinopathy, nephropathy, dyslipidemia, hypertension, and a composite endpoint combining all four outcomes). For each outcome, log-binomial spline regression was applied to estimate the risk and dose-response relationship with diabetes duration and exposures. Results The risk for microvascular complications increased after 14 years since diabetes diagnosis whereas dyslipidemia and hypertension were already prevalent at 10 years. The 15-year risk (95% confidence interval) of the composite endpoint for female and male patients was 22.9% (18.8%–27.9%) and 19.2% (15.5%–23.8%), respectively. Temporal trends suggested a decreasing risk between 2009 and 2016. Glycemic control, lifestyle-related factors, and SES, but not health care-related factors, were associated with the risk of the composite endpoint. Conclusions In early-onset type 1 diabetes, there exists a considerable risk of complications and comorbidities already in young ages. Future research should focus on prevention of diabetic complications in young patients and clarification of pathways of the associations found.

Dental caries,diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta‐analysis

“…Although no statistically significant differences between long and short diabetes duration was found, that was expected since there are known biological and behavioral changes over the time. In fact, diabetes duration is associated with micro and macrovascular complications …”

Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

“…Microvascular complications were identified using ICD codes, which could lead to an underestimation, particularly for retinopathy, as many ophthalmology practices do not integrate their EHR data. Duration of T1D is an important factor for the development of micro‐ and macrovascular diabetes complications . However, this was not robustly captured in the EHR data, although age can be used as a proxy.…”

“…Duration of T1D is an important factor for the development of micro-and macrovascular diabetes complications. 25 However, this was not robustly captured in the EHR data, although age can be used as a proxy. Data on administrative and drug costs were not available, and out-of-network encounters were not captured.…”

Longitudinal Changes in Corneal Cell and Nerve Fiber Morphology in Young Patients with Type 1 Diabetes with and without Diabetic Retinopathy: A 2-Year Follow-up Study

“…1 Microvascular complications can occur in young people with T1DM, [2][3][4] and diabetic retinopathy (DR) is considered to be the earliest and most common complication. 5,6 Optical coherence tomography (OCT) has shown reduced thickness of the retinal nerve fiber and ganglion cell layers in children with T1DM without retinopathy, which is suggestive of early neuronal damage. [6][7][8] Furthermore, in vivo corneal confocal microscopy (IVCCM), a rapid noninvasive ophthalmic imaging technique has also been shown to identify early corneal cellular and nerve fiber pathology in children and adolescents with T1DM, 9 adults with T1DM without neuropathy, 10 or retinopathy or microalbuminuria.…”