Early increase in HbA1c trajectory predicts development of severe microangiopathy in patients with type 1 diabetes: the VISS study

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-05-01 DOI:10.1136/bmjdrc-2023-003917
Hans J Arnqvist, Johnny Ludvigsson, Maria Nordwall
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Abstract

Introduction To study the HbA1c trajectory from the time of diagnosis to examine if patients at the greatest risk for severe microangiopathy can be identified early allowing clinicians to intervene as soon as possible to avoid complications. Research design and methods In a population-based observational study, 447 patients diagnosed with type 1 diabetes before 35 years of age, 1983–1987, were followed from diagnosis until 2019. Mean HbA1c was calculated each year for each patient. Severe diabetic microangiopathy was defined as proliferative diabetic retinopathy (PDR) or macroalbuminuria (nephropathy). Results After 32 years, 27% had developed PDR and 8% macroalbuminuria. Patients with weighted HbA1c (wHbA1c); <57 mmol/mol; <7.4% did not develop PDR or macroalbuminuria. The HbA1c trajectories for patients developing PDR and macroalbuminuria follow separate courses early on and stay separated for 32 years during the follow-up. Patients without severe complications show an initial dip, after which HbA1c slowly increases. HbA1c in patients with severe complications directly rises to a high level within a few years. Mean HbA1c calculated for the period 5–8 years after diabetes onset strongly predicts the development of severe complications. Females with childhood-onset diabetes exhibit a high peak in HbA1c during adolescence associated with higher wHbA1c and higher prevalence of PDR. Conclusions The HbA1c trajectory from diabetes onset shows that mean HbA1c for the period 5–8 years after diagnosis strongly predicts severe microangiopathy. Females with childhood-onset diabetes exhibit a high peak in HbA1c during adolescence associated with higher wHbA1c and a higher prevalence of PDR. Data are available upon reasonable request.
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HbA1c 早期升高轨迹可预测 1 型糖尿病患者严重微血管病变的发展:VISS 研究
引言 研究从确诊时开始的 HbA1c 变化轨迹,以探讨能否及早发现严重微血管病变风险最大的患者,从而使临床医生能够尽早干预,避免并发症的发生。研究设计和方法 在一项基于人群的观察性研究中,研究人员对1983-1987年35岁之前确诊为1型糖尿病的447名患者进行了从确诊到2019年的随访。每年计算每位患者的平均 HbA1c。严重糖尿病微血管病变被定义为增殖性糖尿病视网膜病变(PDR)或大白蛋白尿(肾病)。结果 32 年后,27% 的患者出现了增生性糖尿病视网膜病变,8% 的患者出现了大蛋白尿。加权 HbA1c(wHbA1c)小于 57 mmol/mol;小于 7.4% 的患者没有出现 PDR 或大蛋白尿。发生 PDR 和大蛋白尿的患者的 HbA1c 变化轨迹在早期是分开的,在随访的 32 年中也是分开的。未出现严重并发症的患者的 HbA1c 最初会下降,之后会缓慢上升。有严重并发症的患者的 HbA1c 会在几年内直接升至较高水平。糖尿病发病后 5-8 年计算出的平均 HbA1c 可有力地预测严重并发症的发生。女性儿童糖尿病患者的 HbA1c 在青春期达到高峰,同时 wHbA1c 和 PDR 的发病率也较高。结论 糖尿病发病后的 HbA1c 变化轨迹显示,确诊后 5-8 年间的平均 HbA1c 可强烈预测严重的微血管病变。女性儿童期糖尿病患者在青春期的 HbA1c 峰值较高,与较高的 wHbA1c 和较高的 PDR 患病率有关。如有合理要求,可提供相关数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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