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Chua J, Tan B, Wong D, Garhöfer G, Liew XW, Popa-Cherecheanu A, Loong Chin CW, Milea D, Li-Hsian Chen C, Schmetterer L. Optical coherence tomography angiography of the retina and choroid in systemic diseases. Prog Retin Eye Res 2024; 103:101292. [PMID: 39218142 DOI: 10.1016/j.preteyeres.2024.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Optical coherence tomography angiography (OCTA) has transformed ocular vascular imaging, revealing microvascular changes linked to various systemic diseases. This review explores its applications in diabetes, hypertension, cardiovascular diseases, and neurodegenerative diseases. While OCTA provides a valuable window into the body's microvasculature, interpreting the findings can be complex. Additionally, challenges exist due to the relative non-specificity of its findings where changes observed in OCTA might not be unique to a specific disease, variations between OCTA machines, the lack of a standardized normative database for comparison, and potential image artifacts. Despite these limitations, OCTA holds immense potential for the future. The review highlights promising advancements like quantitative analysis of OCTA images, integration of artificial intelligence for faster and more accurate interpretation, and multi-modal imaging combining OCTA with other techniques for a more comprehensive characterization of the ocular vasculature. Furthermore, OCTA's potential future role in personalized medicine, enabling tailored treatment plans based on individual OCTA findings, community screening programs for early disease detection, and longitudinal studies tracking disease progression over time is also discussed. In conclusion, OCTA presents a significant opportunity to improve our understanding and management of systemic diseases. Addressing current limitations and pursuing these exciting future directions can solidify OCTA as an indispensable tool for diagnosis, monitoring disease progression, and potentially guiding treatment decisions across various systemic health conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Xin Wei Liew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Department of Ophthalmology, Bucharest, Romania
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.
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Warncke K, Eckert A, Bonifacio E, Achenbach P, Kordonouri O, Meissner T, Ohlenschläger U, Bonfig W, Ziegler AG, Holl RW. Characterisation and clinical outcomes in children and adolescents with diabetes according to newly defined subgroups: a cohort study from the DPV registry. EClinicalMedicine 2023; 64:102208. [PMID: 37731934 PMCID: PMC10507204 DOI: 10.1016/j.eclinm.2023.102208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
Background Personalised therapy has emerged as a possibly more efficient approach taking disease heterogeneity into account. The aim of this study was to determine whether recently described subgroups of childhood diabetes have prognostic association with diabetes-specific complications and, therefore, might be a basis for personalised therapies. Methods We applied a previously developed subgroup classification to pediatric patients (diabetes onset <18 years) from the prospective Diabetes Patient Follow-up (DPV) registry with documented data between January 1, 2000 and March 31, 2022, from diabetes centers in Germany, Austria, Switzerland, and Luxembourg. The classification required information on islet autoantibody status, age, haemoglobin A1c (HbA1c), and body-mass index (BMI-SDS) at disease manifestation, as well as follow up data after 2 and after 4 years, which was available in 22,719 patients. Patients without documented data on these parameters were excluded from the analysis. The cumulative risk of severe hypoglycemia, diabetic ketoacidosis (DKA), retinopathy, and nephropathy were analysed by Kaplan-Meier analyses over a median follow-up of 6.8 years (IQR 4.8-9.6). Findings Patients were classified into 10 subgroups (P1-P7 islet autoantibody-positive, n = 19,811; N1-N3 islet autoantibody-negative, n = 2908). The groups varied markedly with respect to specific acute and chronic complications. Severe hypoglycemia was a characteristic feature in young islet autoantibody-positive subgroups P1, P3, P4 (10-year risk 46, 46 and 47%) and the islet autoantibody-negative groups N1, N2 (43 and 46%). Nephropathy was identified in patient groups P2 and P5 (10-year risk 16%), which had features of moderate disease such as preserved C-peptide, low HbA1c, and very low frequency of DKA at diabetes onset. Group P7, which was defined by a high BMI, was associated with poor metabolic control, DKA, and retinopathy. In contrast, islet autoantibody-negative patients with high BMI (N3) had a low risk for all four complications. Interpretation Subgrouping of childhood diabetes at diabetes onset provided prognostic value for the development of acute and chronic diabetes-specific complications. Funding The DPV initiative is supported by The German Ministry of Education and Research (BMBF) within the German Center for Diabetes Research, the diabetes surveillance of the Robert Koch Institute, the German Diabetes Association (DDG) and INNODIA.
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Affiliation(s)
- Katharina Warncke
- Technical University of Munich, Germany; Department of Pediatrics, TUM School of Medicine, Munich, Germany
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany
| | - Alexander Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ezio Bonifacio
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Olga Kordonouri
- Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | | | - Walter Bonfig
- Technical University of Munich, Germany; Department of Pediatrics, TUM School of Medicine, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Martínez-Ortega AJ, Muñoz-Gómez C, Gros-Herguido N, Remón-Ruiz PJ, Acosta-Delgado D, Losada-Viñau F, Pumar-López A, Mangas-Cruz MÁ, González-Navarro I, López-Gallardo G, Bellido V, Soto-Moreno AM. Description of a Cohort of Type 1 Diabetes Patients: Analysis of Comorbidities, Prevalence of Complications and Risk of Hypoglycemia. J Clin Med 2022; 11:1039. [PMID: 35207312 PMCID: PMC8875497 DOI: 10.3390/jcm11041039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite major medical advances, Type 1 Diabetes (T1D) patients still have greater morbimortality than the general population. Our aim was to describe our cohort of T1D patients and identify potential risk factors susceptible to prevention strategies. METHODS Cross-sectional, observational study, including T1D patients treated at our center, from 1 March 2017 to 31 March 2020. INCLUSION CRITERIA T1D, age > 14 years and signed informed consent. EXCLUSION CRITERIA diabetes other than T1D, age < 14 years and/or refusal to participate. RESULTS Study population n = 2181 (49.8% females, median age at enrollment 41 years, median HbA1c 7.7%; 38.24% had at least one comorbidity). Roughly 7.45% had severe hypoglycemia (SH) within the prior year. Macro/microvascular complications were present in 42.09% (5.83% and 41.14%, respectively). The most frequent microvascular complication was diabetic retinopathy (38.02%), and coronary disease (3.21%) was the most frequent macrovascular complication. The risk of complications was higher in males than in females, mainly macrovascular. Patients with SH had a higher risk of complications (OR 1.42; 1.43 in males versus 1.42 in females). CONCLUSIONS Our T1D population is similar to other T1D populations. We should minimize the risk of SH, and male patients should perhaps be treated more aggressively regarding cardiovascular risk factors.
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Affiliation(s)
- Antonio J. Martínez-Ortega
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
- Endocrine Diseases Laboratory, Institute of Biomedicine of Seville, Manuel Siurot Av., 41013 Seville, Spain
| | - Cristina Muñoz-Gómez
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Noelia Gros-Herguido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Pablo Jesús Remón-Ruiz
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Domingo Acosta-Delgado
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Fernando Losada-Viñau
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Alfonso Pumar-López
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Miguel Ángel Mangas-Cruz
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Irene González-Navarro
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Gema López-Gallardo
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Alfonso Manuel Soto-Moreno
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
- Endocrine Diseases Laboratory, Institute of Biomedicine of Seville, Manuel Siurot Av., 41013 Seville, Spain
- Medicine Department, Faculty of Medicine, University of Sevilla, Dr. Fedriani Av., 41009 Seville, Spain
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Salardi S, Porta M, Maltoni G, Bassi M, Minuto N, D'Annunzio G, Baltatescu T, Ariaudo M, Zucchini S, Levantini G, Tumini S, Franceschi R, Cauvin V, Toni S, de Nitto E, Salvatoni A, Schiaffini R. Decreasing prevalence of retinopathy in childhood-onset type 1 diabetes over the last decade: A comparison of two cohorts diagnosed 10 years apart. Diabetes Obes Metab 2021; 23:1950-1955. [PMID: 33999510 DOI: 10.1111/dom.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
AIM To ascertain whether the prevalence of retinopathy has declined over the last 2 decades in individuals with childhood-onset type 1 diabetes and whether this might be explained by changes in lifetime HbA1c. MATERIALS AND METHODS A multicentre, retrospective, observational study, comparing 128 subjects with diabetes onset in 2000-2003 assessed for retinopathy in 2016-2019, with a previous cohort of 115 individuals diagnosed in 1990-1993 and assessed for retinopathy in 2007-2009, was conducted. The two cohorts had both a similar diabetes duration and age at diagnosis. Retinal photographs were centrally graded. Lifetime HbA1c and its variability, estimated as the ratio between intrapersonal mean and standard deviation of HbA1c, were evaluated. RESULTS The prevalence of any retinopathy in the new and old cohort was 24.2% and 43.5% (P < .003), respectively, and that of severe retinopathy was 1.7% and 9.6% (P = .018). Lifetime HbA1c was lower in the new cohort (7.8% ± 0.8% vs. 8.1% ± 0.8%; P = .002) during all periods following the first 5 years after diagnosis. Patients without retinopathy in the two cohorts had similar levels of HbA1c. Compared with patients without retinopathy, those with retinopathy had higher lifetime HbA1c and long-term HbA1c variability. However, on multiple regression analysis, only lifetime HbA1c was independently associated with retinopathy (P = .0018). CONCLUSIONS The risk of developing retinopathy was nearly halved in children who developed type 1 diabetes in the new millennium compared with previous cohorts. These results confirm that maintaining the lowest possible levels of HbA1c throughout lifetime protects from diabetic retinopathy.
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Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Porta
- Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Giuseppe D'Annunzio
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Tamara Baltatescu
- Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Ariaudo
- Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Stefano Tumini
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | | | - Sonia Toni
- Meyer Pediatric Institute, University of Firenze, Florence, Italy
| | - Elena de Nitto
- Meyer Pediatric Institute, University of Firenze, Florence, Italy
| | | | - Riccardo Schiaffini
- Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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EARLY RETINAL MICROVASCULAR ABNORMALITIES IN YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CLINICALLY EVIDENT DIABETIC RETINOPATHY. Retina 2021; 41:1478-1486. [PMID: 33252580 DOI: 10.1097/iae.0000000000003047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize the early retinal microvascular changes in young adults (age: 22.69 ± 3.50 years) with Type 1 diabetes mellitus without clinically detectable diabetic retinopathy using optical coherence tomography angiography and investigate the associated factors. METHODS A total of 36 participants with Type 1 diabetes mellitus (70 eyes) and 34 healthy controls (57 eyes) were retrospectively reviewed. The analyzed optical coherence tomography angiography indices included capillary vessel density, foveal avascular zone area/perimeter/acircularity index, and foveal vascular density, acquired in the 6 × 6-mm2 area centered on the fovea. The generalized estimation equations model was applied to compare the mean values and to study the associated factors. RESULTS In subjects with diabetes, statistically significant decreases were observed in parafoveal vessel density in both superficial and deep capillary plexuses, foveal avascular zone area/perimeter, and foveal vascular density when compared with controls (all P < 0.05). Higher glycated hemoglobin level was independently associated with the decrease of parafoveal vessel density as well as the increase of foveal avascular zone area/perimeter (all P < 0.05). Prepubescent onset of diabetes mellitus was also independently associated with the decrease of superficial parafoveal vessel density, foveal avascular zone area/perimeter, and foveal vascular density (P = 0.015, 0.011, 0.015, and 0.001, respectively). CONCLUSION In young adults with Type 1 diabetes mellitus lacking clinical signs of diabetic retinopathy, optical coherence tomography angiography revealed alterations in retinal microvasculature that were associated with glycated hemoglobin level and onset of diabetes mellitus related to puberty.
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Samuelsson U, Anderzen J, Åkesson K, Hanberger L. The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications. Acta Paediatr 2021; 110:1264-1272. [PMID: 32978990 DOI: 10.1111/apa.15591] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether a very low glycated haemoglobin A (HbA1c) (<48 mmol/mol, 6.5%) during childhood compared to higher HbA1c values further decreases the risk for microvascular complications. METHODS Data were included from the 5116 patients with type 1 diabetes transferred from the Swedish paediatric diabetes quality registry to the Swedish National Diabetes Register (NDR), until 2014. All HbA1c values ever registered in the paediatric registry were used to divide patients into six groups based on the mean HbA1c. Values were compared with HbA1c registered in 2013 and 2014 in NDR, together with data on retinopathy, micro- and macroalbuminuria, age at onset and duration of diabetes. RESULTS The group with lowest mean-HbA1c during childhood had also the lowest mean as young adults during 2013 and 2014. The most common complication as young adults was retinopathy. The proportion with macroalbuminuria was 3% in the lowest HbA1c group during childhood and 3.9% in the highest group, and lower in the groups in between. Microalbuminuria had the same pattern. Retinopathy increased with each HbA1c group. CONCLUSION Children with the lowest HbA1c values had the lowest HbA1c values as adults. HbA1c was associated with retinopathy but the relationship with albuminuria was not obvious.
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Affiliation(s)
- Ulf Samuelsson
- Division of Paediatrics Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Johan Anderzen
- Department of Paediatrics County Hospital Ryhov Jönköping Sweden
| | - Karin Åkesson
- Division of Paediatrics Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Paediatrics County Hospital Ryhov Jönköping Sweden
| | - Lena Hanberger
- Division of Nursing and Reproductive Health Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
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Gubitosi-Klug RA, Bebu I, White NH, Malone J, Miller R, Lorenzi GM, Hainsworth DP, Trapani VR, Lachin JM, Tamborlane WV, Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Screening eye exams in youth with type 1 diabetes under 18 years of age: Once may be enough? Pediatr Diabetes 2019; 20:743-749. [PMID: 31206973 PMCID: PMC7217664 DOI: 10.1111/pedi.12877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 01/25/2023] Open
Abstract
Case series and registry data suggest that diabetic retinopathy requiring treatment is rare in youth with type 1 diabetes (T1D) prior to 18 years of age. We evaluated this question in the standardized clinical trial setting by retrospectively reviewing diabetic retinopathy examinations from participants in the Diabetes Control and Complications Trial (DCCT) who were 13 to <18 years of age at randomization. Standardized stereoscopic 7-field fundus photographs were obtained every 6 months during DCCT (1983-1993). Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Transitions in diabetic retinopathy status over time were described. A total of 195 participants with median baseline glycated hemoglobin (HbA1c) of 9.3% (103 in the conventional and 92 in the intensive treatment groups) had an average of 5.3 diabetic retinopathy assessments during 2.3 years of follow-up (range 1-11) while under 18 years of age during the DCCT. No participant developed severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy and only one participant (in the intensive group) reached clinically significant macular edema (CSME) while less than 18 years of age. In this incident case, baseline characteristics included diabetes duration 9.3 years, HbA1c 10.3%, LDL 131 mg/dL, and mild non-proliferative diabetic retinopathy (35/35 ETDRS scale); CSME resolved without treatment. Similar analyses using age cut-offs of <19, 20, or 21 years showed a slight rise in diabetic retinopathy requiring treatment over late adolescence. Clinical trial evidence suggests that frequent eye exams may not be universally necessary in youth <18 years of age with T1D.
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Affiliation(s)
| | - Ionut Bebu
- George Washington University, Rockville, MD
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Nordwall M, Fredriksson M, Ludvigsson J, Arnqvist HJ. Impact of Age of Onset, Puberty, and Glycemic Control Followed From Diagnosis on Incidence of Retinopathy in Type 1 Diabetes: The VISS Study. Diabetes Care 2019; 42:609-616. [PMID: 30705061 DOI: 10.2337/dc18-1950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/21/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate sex, age at diabetes onset, puberty, and HbA1c, with subjects followed from diabetes diagnosis and during different time periods, as risk factors for developing diabetic simplex and proliferative retinopathy. RESEARCH DESIGN AND METHODS In a population-based observational study, HbA1c for 451 patients diagnosed with diabetes before 35 years of age during 1983-1987 in southeast Sweden was followed for up to 18-24 years from diagnosis. Long-term mean weighted HbA1c (wHbA1c) was calculated. Retinopathy was evaluated by fundus photography and analyzed in relation to wHbA1c levels. RESULTS Lower wHbA1c, diabetes onset ≤5 years of age, and diabetes onset before puberty, but not sex, were associated with longer time to appearance of simplex retinopathy. Proliferative retinopathy was associated only with wHbA1c. The time to first appearance of any retinopathy decreased with increasing wHbA1c. Lower wHbA1c after ≤5 years' diabetes duration was associated with later onset of simplex retinopathy but not proliferative retinopathy. With time, most patients developed simplex retinopathy, except for those of the category wHbA1c ≤50 mmol/mol (6.7%), for which 20 of 36 patients were without any retinopathy at the end of the follow-up in contrast to none of 49 with wHbA1c >80 mmol/mol (9.5%). CONCLUSIONS Onset at ≤5 years of age and lower wHbA1c the first 5 years after diagnosis are associated with longer duration before development of simplex retinopathy. There is a strong positive association between long-term mean HbA1c measured from diagnosis and up to 20 years and appearance of both simplex and proliferative retinopathy.
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Affiliation(s)
- Maria Nordwall
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Östergötland, Sweden.,Vrinnevi Hospital, Norrköping, Östergötland, Sweden
| | - Mats Fredriksson
- Division of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Östergötland, Sweden.,Forum Östergötland, Linköping University, Linköping, Östergötland, Sweden
| | - Johnny Ludvigsson
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Östergötland, Sweden.,Division of Paediatrics, Department of Clinical and Experimental Medicine, Crown Princess Victoria Children's Hospital, Linköping University, Linköping, Östergötland, Sweden
| | - Hans J Arnqvist
- Departments of Endocrinology and Clinical and Experimental Medicine, Linköping University, Linköping, Östergötland, Sweden
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DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:105-114. [PMID: 30058221 DOI: 10.1111/pedi.12737] [Citation(s) in RCA: 392] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
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10
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Forga L, Goñi MJ, Ibáñez B, Cambra K, García-Mouriz M, Iriarte A. Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes. J Diabetes Res 2016; 2016:9898309. [PMID: 27213158 PMCID: PMC4861784 DOI: 10.1155/2016/9898309] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 02/07/2023] Open
Abstract
Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset. Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables. Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10-14, 15-29, 30-44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure. Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.
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Affiliation(s)
- Luis Forga
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
- *Luis Forga:
| | - María José Goñi
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Berta Ibáñez
- Navarrabiomed, Fundación Miguel Servet, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Koldo Cambra
- Navarrabiomed, Fundación Miguel Servet, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Marta García-Mouriz
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Ana Iriarte
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
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